TY  - JOUR
T1  - Aspirin use and all-cause mortality among patients being evaluated for known or suspected coronary artery disease: A propensity analysis
AU  - Gum PA, Thamilarasan M, Watanabe J, Blackstone EH, Lauer MS
Y1  - 2001/09/12
N1  - 10.1001/jama.286.10.1187
JO  - JAMA
SP  - 1187
EP  - 1194
VL  - 286
IS  - 10
N2  - Context 
                  Although aspirin has been shown to reduce cardiovascular morbidity and
short-term mortality following acute myocardial infarction, the association
between its use and long-term all-cause mortality has not been well defined.Objectives 
                  To determine whether aspirin is associated with a mortality benefit
in stable patients with known or suspected coronary disease and to identify
patient characteristics that predict the maximum absolute mortality benefit
from aspirin.Design and Setting 
                  Prospective, nonrandomized, observational cohort study conducted between
1990 and 1998 at an academic medical institution, with a median follow-up
of 3.1 years.Patients 
                  Of 6174 consecutive adults undergoing stress echocardiography for evaluation
of known or suspected coronary disease, 2310 (37%) were taking aspirin. Patients
with significant valvular disease or documented contraindication to aspirin
use, including peptic ulcer disease, renal insufficiency, and use of nonsteroidal
anti-inflammatory drugs, were excluded.Main Outcome Measure 
                  All-cause mortality according to aspirin use.Results 
                  During 3.1 years of follow-up, 276 patients (4.5%) died. In a simple
univariable analysis, there was no association between aspirin use and mortality
(4.5% vs 4.5%). However, after adjustment for age, sex, standard cardiovascular
risk factors, use of other medications, coronary disease history, ejection
fraction, exercise capacity, heart rate recovery, and echocardiographic ischemia,
aspirin use was associated with reduced mortality (hazard ratio [HR], 0.67;
95% confidence interval [CI], 0.51-0.87; P = .002).
In further analysis using matching by propensity score, 1351 patients who
were taking aspirin were at lower risk for death than 1351 patients not using
aspirin (4% vs 8%, respectively; HR, 0.53 ; 95% CI, 0.38-0.74; P = .002). After adjusting for the propensity for using aspirin, as
well as other possible confounders and interactions, aspirin use remained
associated with a lower risk for death (adjusted HR, 0.56; 95% CI, 0.40-0.78; P<.001). The patient characteristics associated with
the most aspirin-related reductions in mortality were older age, known coronary
artery disease, and impaired exercise capacity.Conclusion 
                  Aspirin use among patients undergoing stress echocardiography was independently
associated with reduced long-term all-cause mortality, particularly among
older patients, those with known coronary artery disease, and those with impaired
exercise capacity.
SN  - 0098-7484
M3  - doi: 10.1001/jama.286.10.1187
UR  - http://dx.doi.org/10.1001/jama.286.10.1187
ER  -