Abstract 3476: Increased Prevalence of Aspirin Non-Responsiveness in Heart Failure Patients: Results from the Aspirin Resistance Testing and Initial Strategy for Treatment (ARTIST) Multicenter Trial
Introduction: Patients with heart failure (HF) have a high prevalence of coronary artery disease (CAD) and are at significant risk for an acute coronary syndrome (ACS). To mitigate this risk they are often prescribed aspirin (ASA), however the prevalence of ASA non-responsiveness in HF patients is unknown. We studied patients with suspected ACS to determine the prevalence of ASA resistance among those with a history of HF.
Methods: We enrolled 1010 suspected ACS patients who presented to one of 5 emergency departments (ED’s); a complete medical history was available in 987. All patients were on outpatient ASA therapy or received ASA in the ED, and were excluded if on clopidogrel. Blood was tested for ASA responsiveness on a VerifyNow® (Accumetrics) device. Non-responsiveness was defined as ASA reactive units (ARU) ≥ 550.
Results: Prevalence of ASA non-responsiveness overall was 10.3% (95% C.I. 8.6–12.3%). The 22% of patients with a history of HF had a higher prevalence of CAD (58% vs 28%), hypertension (89% vs 71%), diabetes (45% vs 30%), and chronic renal insufficiency (24% vs 5%); had higher BNP levels (861 vs 156 pg/ml); and were more likely to be taking ASA as an outpatient (77% vs 51%) (p < 0.001 for all) than those without a history of HF, but did not differ by age, sex, BMI, or smoking status. Patients with a history of HF had a higher prevalence of ASA non-responsiveness and higher mean ARU (Figure⇓).
Conclusions: Among patients presenting to the ED with suspected ACS, those with a history of HF have an increased prevalence of ASA non-responsiveness. ASA responsiveness testing may be important in the acute assessment of HF patients who present with ACS, to help optimize antithrombotic therapies.