An Evaluation of Aspirin Treatment Preferences ORIGINAL INVESTIGATION of Physicians in Hypertensive Patients in Terms of Current Guidelines: A Subgroup Analysis of the ASSOS Trial in Turkey.

BACKGROUND: The Appropriateness of Aspirin Use in Medical Outpatients: A Multicenter, Observational Study trial has been the largest study ever conducted among patients in Turkey regarding aspirin treatment. In the subgroup analysis of the hypertensive group of the Appropriateness of Aspirin Use in Medical Outpatients: A Multicenter, Observational Study trial, we aimed to evaluate the physicians' adherence to current guidelines regarding their aspirin treatment preferences. METHODS: The Appropriateness of Aspirin Use in Medical Outpatients: A Multicenter, Observational Study trial is a cross-sectional and multicenter study conducted among 5007 consecutive patients aged ≥18 years. The study population consisted of outpatients on aspirin treatment (80-300 mg). The patient data were obtained from 30 different cardiology clinics of 14 cities from all over Turkey. In this subgroup analysis, patients were divided into 2 groups: the hypertensive group (n=3467, 69.3%) and the group without hypertension (n=1540, 30.7%) according to the 2018 European Society of Cardiology/ European Society of Hypertension Guidelines for the Management of Arterial Hypertension. RESULTS: Aspirin use for primary prevention was higher in patients with hypertension compared to patients without hypertension [328 (21.3%); 1046 (30.2%); P < .001]. Treatment with a dose of 150 mg aspirin (n=172, 5%) was mostly preferred by internists for hypertensive patients (n =226, 6.5%); however, a daily dose of 80-100 mg aspirin therapy (n=1457, 94.6%) was mostly prescribed by cardiologists (n=1347, 87.5%) for patients without hypertension. CONCLUSION: Aspirin was found to be used commonly among patients with hypertension for primary prevention despite the current European Society of Cardiology Arterial Hypertension Guideline not recommending aspirin for primary prevention in patients with hypertension.

Inappropriate Use of Aspirin in Real-Life Cardiology Practice: Results from the Appropriateness of Aspirin Use in Medical Outpatients: A Multicenter, Observational Study (ASSOS) Study.

BACKGROUND: Indications and appropriateness of aspirin use have not been well investigated in Turkey. AIMS: To investigate the prescription patterns and appropriateness of aspirin in a real-world clinical setting. STUDY DESIGN: Cross-sectional study. METHODS: The Appropriateness of Aspirin Use in Medical Outpatients: A Multicenter, Observational Study (ASSOS) is a cross-sectional and multicenter study that included 5007 consecutive patients aged 18 or over who presented to 30 different cardiology outpatient clinics from 14 cities throughout Turkey. Only patients using aspirin (80-325 mg) were included. The study population was divided into 2 groups regarding the use of aspirin: primary prevention (PP) group and secondary prevention (SP) group. The indication of aspirin use was evaluated following the 2016 European Society of Cardiology (ESC) and the 2016 United States Preventative Services Task Force (USPTF) guidelines in the PP group. RESULTS: A total of 5007 patients (mean age 62.15 ± 11.05, 39% female) were enrolled. The PP group included 1132 (22.6%) patients, and the SP group included 3875 (77.4%) patients. Of the 1132 patients, inappropriate use of aspirin was determined in 100% of the patients according to the ESC guidelines, and 71% of the patients according to the USPTF guidelines. Multivariate logistic regression analysis showed age OR: 0.98 CI (0.97-0.99) P = .037, smoking OR: 0.60 CI (0.44-0.82) P = .001, heart failure OR: 2.11 CI (1.14-3.92) P = .017, hypertension OR: 0.51 CI (0.36-0.74) P < .001, diabetes mellitus OR: 0.34 CI (0.25-0.47) P < .001, oral anticoagulant use OR: 3.01 CI (1.10-8.25) P = .032, and female sex OR: 2.73 CI (1.96-3.80) P < .001 were independent predictors of inappropriate aspirin use in PP patients. CONCLUSION: Although there are considerable differences between the USPTF and the ESC guidelines with respect to recommendations for aspirin use in PP, inappropriate use of aspirin in Turkey is frequent in real-world practice for both guidelines. Besides, heart failure, oral anticoagulant use, and the female sex of the patients were independent predictors of inappropriate use of aspirin.

The association between coronary atherosclerotic burden and asymmetric dimethylarginine, carotis intima media thickness and endothelial function.

OBJECTIVES: Detection of extent and severity of atherosclerosis using easy, non-invasive methods is of great importance. Atherosclerotic burden may be evaluated with the Gensini scoring system (GSS). Carotis intima media thickness (CIMT), plasma asymmetric dimethyl arginine (ADMA) level, and endothelial dysfunction are well known surrogate markers of atherosclerosis. The aim of this study was to evaluate the relationship between atherosclerotic burden determined by the GSS, and ADMA, CIMT and endothelial function. STUDY DESIGN: Consecutive patients who had undergone coronary angiography were evaluated. 50 patients with acute coronary syndrome (ACS), 50 patients with stable coronary artery disease (SCA), and 50 patients with normal coronary arteries (NCA) were included. All subjects' GSS, ADMA, CIMT and endothelial functions were evaluated and compared. RESULTS: GSS was higher in ACS than SCA (75.4 vs 54.9; p<0.001). CIMT was higher in ACS and SCA in compared to NCA (0.98, 0.96, 0.78 mm respectively; p<0.001). Endothelium derived vasodilatory response (EDVR) was decreased in ACS and SCA in compared to NCA (3.5±2.1%, 3.3±1.8%, 7.2±3.5% respectively; p<0.001). Plasma ADMA concentration was higher in ACS and SCA in compared to NCA (0.928, 0.992, 0.475 µmol/l respectively; p<0.001). There was a weak positive correlation between GSS and plasma ADMA levels (r=0.293; p=0.002), an intermediate positive correlation between GSS and CIMT (r=0.508; p<0.001), and an intermediate negative correlations between GSS and EDVR (r= -0.662; p<0.001). CONCLUSION: This study showed that CIMT, ADMA concentration and endothelial dysfunction were significantly associated with CAD. However, only the GSS was significantly different between ACS and SCA groups.

Treatment of saphenous vein graft lesions with paclitaxel- and sirolimus-eluting stents: comparison of short- and long-term clinical outcomes.

OBJECTIVE: The purpose of this study was to compare treatment of saphenous vein graft (SVG) lesions with paclitaxel-eluting (PES) and sirolimus-eluting stents (SES) in daily practice with regard to short- and long-term clinical outcomes. METHODS: Between August 2002 and September 2006, a total of 71 patients with SVG lesions who were implanted PES or SES with percutaneous coronary intervention in our center were evaluated retrospectively. Forty-six patients with PES (PES group) were compared to twenty-five patients treated with SES (SES group) in terms of in-hospital, 30-day, six-months and 1-year clinical outcomes. Statistical analyses were performed using Chi-Square statistics or Fisher's exact and independent sample t test. Survival analysis was done using Kaplan-Meier method and log-rank test. RESULTS: Baseline clinical characteristics were similar in both groups except for a tendency toward a lower age in the SES group. No statistically significant difference was found between two groups by means of lesion and procedural characteristics. All clinical outcomes at 30-day, 6-month and 1-year after the interventions were similar in both groups. Early stent thrombosis was detected in one patient (2.2%) of PES group (p=0.65). Late stent thrombosis was not observed in both groups. The rate of major adverse cardiac events at 1-year was 8.7% in the PES group and 16% in the SES group (p=0.44). CONCLUSION: Short-and long-term clinical outcomes of PES and SES in the treatment of SVG lesions are similar. The results of our study showed that both drug-eluting stents are effective and safe in real-world patient with diseased SVGs.