Risultati per: Long COVID: principali risultati, meccanismi e raccomandazioni

Circulation, Volume 150, Issue Suppl_1, Page A4138374-A4138374, November 12, 2024. Introduction:Although coronary endothelial dysfunction is thought to affect coronary atherothrombogenic processes, there has been little practical evidence for the relationship between clinical evolution of fatal or non-fatal acute coronary syndrome and coronary endothelial dysfunction.Hypothesis:We assessed hypothesis that coronary endothelial dysfunction has clinical impacts on development of acute coronary syndrome and fatal cardiovascular events.Methods:Coronary endothelial dysfunction was practically graded by the flow-mediated endothelium-dependent reactive changes in coronary artery diameter (CFMD) to infusion of adenosine triphosphate (ATP ; 50μg) into the normal left coronary artery using quantitative coronary arteriography in 150 patients with stable coronary artery disease. The enrolled patients were categorized into tertile groups according to the values of CFMD, and we prospectively followed-up major adverse clinical cardiac events including acute coronary syndrome and cardiovascular death.Results:For a mean follow-up period of 132 months (range; 120 to 144) with complete follow-up, the patients in the lower third with severe coronary endothelial dysfunction (Group-L) more frequently developed acute coronary syndrome than those in the middle third with mild coronary endothelial dysfunction (Group-M) plus those in the higher third without coronary endothelial dysfunction (Group-H) [Group-L versus Group-M plus Group-H: 15(30%) versus 5(10%) plus 0(0%), p

Circulation, Volume 150, Issue Suppl_1, Page A4147420-A4147420, November 12, 2024. Introduction:Electronic cigarettes (e-cig) have been promoted as nicotine (NIC) delivery systems without the adverse effects of tobacco cigarettes; however, the increasing popularity of EC has prompted concerns about their potential cardiovascular (CV) toxicity. As e-cig are relatively new products, their long-term CV effects over the lifetime of the user remain unclear. We developed a mouse model of chronic e-cig exposure that mimics human NIC exposure levels to simulate long-term human use.Objective:To characterize the effects of long-term e-cig exposure on the structure, contractile function and electrophysiological function of the heart with exposures for >50% of life-span.Methods:C57/BL6 male mice were exposed to either air (25 mice) or aerosol from e-cig liquid containing 24 mg/ml NIC (25 mice) for 3 hours/day, 5 days/week, over 64 weeks. Blood pressure (BP) was measured by tail-cuff. Echocardiography was performed to assess the structure and function of the left ventricle (LV) and right ventricle (RV). High-resolution 3D visualization of LV and RV was also performed by cardiac CINE-MRI. Cardiac rate and electrophysiology was measured by electrocardiography (ECG).Results:Compared to the air control group, e-cig exposure for 64 weeks led to major changes in heart structure and function (Table 1). Marked elevations in systolic BP (SBP), diastolic BP (DBP), and mean BP (MBP) of 49%, 66%, and 63%, respectively, were observed. Echocardiography revealed concentric LV hypertrophy (LVH) with increases in both LV and RV end-diastolic and end-systolic wall thicknesses. LV mass was 43% increased. Marked RV hypertrophy (RVH) was also observed. The presence of LVH and RVH was confirmed on cardiac MRI. ECG exhibited 6% slower heart rate with e-cig exposure along with 23% prolonged PR interval and 91% increase in P wave duration. QT interval was 20% prolonged indicative of delayed ventricular depolarization and repolarization.Conclusions:Long term e-cig exposure caused hypertension with LV and RV hypertrophy with alterations in atrial and ventricular conduction seen. Thus, long-term e-cig use may predispose to hypertrophic heart disease and cardiac conduction abnormalities.

Circulation, Volume 150, Issue Suppl_1, Page A4144277-A4144277, November 12, 2024. Background:The role of fractional flow reserve (FFR) in intermediate lesions has been widely demonstrated and recommended by guidelines. However, the long-term outcomes in patient with an intermediate stenosis received FFR have not yet been investigated comprehensively.Methods:We retrospective included 558 patients underwent both coronary artery angiography (CAG) and FFR. All patients were randomly divided into a training set containing 390 individuals and a validation set of 168 individuals at a ratio of 7:3. Valuable predictors were screened for constructing nomogram by statistical and clinical significance. The prediction efficiency of nomogram was evaluated by multiple methods, including C-index, area under the curve (AUC), calibration curves and decision-curve analysis (DCA).Results:During a median follow-up of 6.2 years, 87 (15.59%) adverse events were documented. The nomogram consists of age, smoking, hypertension, diabetes mellitus (DM), hyperuricemia, and FFR≤0.8 six factors. The C-index in the training and validation sets were 0.807 and 0.832. The AUC of 3-year, 5-year, 7-year receiver operating characteristic (ROC) curves of training set were 0.697, 0.823, 0.854, and of validation set were 0.845, 0.824, 0.856. The calibration curves and DCAs illustrated the ability of the nomogram to predict long-term adverse outcomes and its net benefits in clinical practice.Conclusions:Age, DM, and hyperuricemia were independently associated with longterm adverse outcomes, and the constructed nomogram based on FFR may be used as a visible tool to predict long-term adverse outcomes for coronary artery disease (CAD) patients with an intermediate stenosis.

Circulation, Volume 150, Issue Suppl_1, Page A4146116-A4146116, November 12, 2024. Introduction:Sleep apnea is an independent risk factor for hypertension. Chronic intermittent hypoxia (CIH), a key feature of sleep apnea, is considered the main factor for the development of hypertension, which is attributed to sympathoexcitation. However, novel evidence shows that CIH enhanced CB chemosensory discharges triggering an increase in sympathetic outflow through neuronal activation in the nucleus of the solitary tract (NTS). This idea is supported by the fact that CB ablation abolish the hypertension and NTS neuroinflammation after 21 days of CIH even in the presence of CIH. However, whether CB mediate glial cell activation (well-known sentinels involved in brain inflammation) following long-term CIH remains unknown.Hypothesis:Accordingly, we propose that the maintenance of hypertension and glia cell activation within the NTS of mice exposed to long-term CIH, depends on the CB afferent discharge.Methods:We exposed male C57BL6 mice to CIH (5% FiO2, 12 times/h, 8 h/day) for 60 days. At 45 days of CIH, CBs were selectively denervated, and animals were kept in CIH for additional 15 days. At the end of the experiments, we measured arterial blood pressure (MABP), hypoxic ventilatory response (HVR) in awake mice and assessed astrocyte and microglia activity through morphological 3D reconstructions, and IL-1β, IL-6, and TNF-α gene expression in the NTS with real-time PCR.Results:CIH induces hypertension (MABP 83.5±1.4 vs. 95.0±2.2 mmHg; Sham vs CIH), enhances HVR (1.69±0.2 vs 4.3±0.9 VE/min; Sham vs. CIH), and change astrocytes morphology (N° of branches 13.0±0.7 vs 11.3±0.5; cable length 181.0±8.9 vs 148.1±1.5 pm, Sham vs CIH), and microglia arborization (N° of branches 196.1±8.4 vs 376.3±16.8; cable length 667.4±29.6 vs 1267±60.5 pm, Sham vs CIH). Remarkably, CB denervation (CIHd) normalized the hypertension (MABP 83.5±1.4 mmHg; CIHd), the enhanced HVR (1.63±0.43 VE/min; CIHd), reduced the increased IL-6 (1.2± 0.2 vs 0.4 ± 0.1, CIH vs CIHd), TNF-α (2.0±0.2 vs 1.1±0.2, CIH vs CIHd) but not IL-1β levels (3.0±0.4 CIH vs 2.6±0.5, CIH vs CIHd), and the changes observed in astrocytes (N° of branches 17.2±0.9, cable length 231.0±12.9) and microglia (N° of branches 126.2±13.3; cable length 126.2±1.3 CIHd).Conclusions:Present results suggest that CBs plays a critical role in the maintenance of high blood pressure and contribute to the inflammation in the NTS of mice exposed to long-term CIH. Supported by Fondecyt Grants 1211443 and 1220950.

Circulation, Volume 150, Issue Suppl_1, Page A4128187-A4128187, November 12, 2024. Background:Minority patients are disproportionately affected by heart failure. Therefore, we aimed to determine the impact of race on health-related quality of life in three groups of older patients (60-80 years) with heart failure who underwent advanced surgical therapies (within race and by surgery group): (1) heart transplantation (HT, with pre-transplant mechanical circulatory support [HT MCS]), (2) HT without pre-transplant MCS (HT Non-MCS), or (3) long-term MCS, if ineligible for HT.Methods:Secondary analyses were conducted using data from the Sustaining Quality of Life of the Aged: Heart Transplant or Mechanical Support study. From 10/1/15 to 12/31/18, 396 patients with heart failure were recruited at 13 U.S. medical centers, of which 305 patients underwent HT (n=161 [68 HT MCS and 93 HT Non-MCS]) or long-term MCS (n=144) and had data through 1 year follow-up. Analysis included non-inferiority testing (Long-term MCS vs HT MCS; Long-term MCS vs HT Non-MCS). To demonstrate non-inferiority, the surgical strategies by race needed to show a difference of at least 5 percentage points, with a 95% lower confidence boundary and a two-tailed p-value

Circulation, Volume 150, Issue Suppl_1, Page A4145470-A4145470, November 12, 2024. Background:The novel concept of metabolic dysfunction-associated steatotic liver disease (MASLD) emerged to facilitate diagnosis and emphasize the underlying pathophysiology. However, research validating its prognostic significance, especially for nonatherosclerotic outcomes, is lacking.Hypothesis:MASLD is associated with an increased risk of cardiovascular disease.Aim:To determine the prognostic impact of MASLD on cardiac failure, arrhythmias, arrest, key atherosclerotic cardiovascular outcomes, and all-cause mortality.Methods:In this nationwide retrospective cohort study involving 61 centers, a total of 17,073,511 adults evaluated from 2014 to 2024 were categorized into MASLD and two control groups differing on metabolic dysfunction status. We adjusted for traditional cardiovascular risk factors using propensity score matching with a greedy nearest-neighbor algorithm and 0.1-caliper for pooled standardized mean differences. Cox regressions were used to compare all-cause mortality and cardiovascular outcomes between MASLD and reference groups.Results:After a 10-year follow-up, patients with MASLD exhibited greater risks for atrial fibrillation (HR, 1.53; 95% CI, 1.51–1.56), atrial flutter (HR, 1.85; 95% CI, 1.78–1.91), ventricular tachycardia (HR, 2.04; 95% CI, 1.97–2.11), ventricular fibrillation/flutter (HR, 2.18; 95% CI, 2.00–2.37), cardiac arrest (HR, 2.64; 95% CI, 2.53–2.78), heart failure with preserved ejection fraction (HR, 2.69; 95% CI, 2.63–2.74), heart failure with reduced ejection fraction (HFrEF), ischemic heart diseases, stroke, and all-cause mortality compared with patients without metabolic dysfunction. Comparisons between MASLD and metabolic dysfunction yielded significant associations for increased risk with MASLD, except for HFrEF.Conclusion:MASLD is a strong independent risk factor for mortality, nonatherosclerotic, and atherosclerotic cardiovascular outcomes.

Circulation, Volume 150, Issue Suppl_1, Page A4145353-A4145353, November 12, 2024. Background:Myocardial injury complicating percutaneous coronary intervention (PCI) is associated with mortality, but sex differences in outcomes are uncertain. We explored sex differences in the incidence and long-term outcomes of post-PCI myocardial injury (PPMI).Methods:Adults who underwent PCI at NYU between 2011-2020 were included in this retrospective analysis. Patients with ACS as the indication for PCI were excluded. PPMI was defined as a peak CKMB concentration >99% of the upper reference limit. The incidence of PPMI by sex was compared by Chi-square tests. Independent predictors of elevated CKMB post-PCI were evaluated with linear regression models in subgroups by sex. Cox proportional hazard models were generated to evaluate relationships between PPMI and all-cause mortality by sex.Results:Of 10,807 adults undergoing PCI, 24.9% (2,694) were female. Females were older than males at the time of PCI (68.9 vs. 65.8, p

Circulation, Volume 150, Issue Suppl_1, Page A4134957-A4134957, November 12, 2024. Background:Dilated cardiomyopathy (DCM) is the most common cause of pediatric heart failure (HF), but there is limited literature on its long-term prognosis and treatment outcomes. We examined risk factors for long-term morbidity and mortality and outcomes of care in childhood-onset DCM.Methods:Electronic medical records from a tertiary care pediatric hospital (SickKids, Toronto, Canada) were used to retrospectively follow children ages 0–18 years with DCM from January 1, 2001 to July 1, 2017. Provincial healthcare administrative data was used to monitor outcomes recorded outside of SickKids, following patients during the same time period and into adulthood (age >18 years) until August 31, 2023. We compared DCM cases, with or without echocardiographic recovery (LVEDD z score < 2 and LVEF ≥ 55%), and controls matched on sex, age, and urban/rural residence on a range of health and health service outcomes. Primary outcomes included all-cause mortality, heart transplant (HT), and inpatient admission for HF. Among cases, Cox proportional hazards regression with backwards selection was used to identify demographic, disease, and treatment characteristics associated with each primary outcome, with candidate variables selected based on univariate analysis and clinical judgment.Results:We studied 156 patients with DCM and 780 controls for a median of 14.8 years. Median age at the end of follow-up was 16.2 years. Compared with controls, DCM cases had higher rates of all-cause death, HT, and HF admission (allP

Circulation, Volume 150, Issue Suppl_1, Page A4139661-A4139661, November 12, 2024. Introduction:Troponin-defined myocardial injury or N-terminal pro-B-type natriuretic peptide (NT-proBNP) elevation frequently coincides with coronavirus disease 2019 (COVID-19). Our prior study (COVID-MI Registry Cohort-1) confirmed that high-sensitive troponin I (HsTnI) and NT-proBNP effectively stratified mortality risk. However, variants of severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) change rapidly, and it remains unclear whether these biomarkers are consistently effective in predicting prognosis of COVID-19 patients irrespective of epidemic periods.Research Questions:Can HsTnI or NT-proBNP stratify mortality risk in recent COVID-19 cohorts?Aims:To assess the potential of HsTnI and NT-proBNP levels for risk stratification in the recent COVID-19 waves.Methods:In the COVID-MI Registry Cohort-2, we enrolled 1115 consecutive COVID-19 patients admitted between October 2021 and October 2022, during the Omicron variant endemic. We collected data of HsTnI or NT-proBNP levels from hospital charts or using the samples in our hospital’s serum/plasma bank if the data were not available. The primary outcome measure was all-cause mortality.Results:On admission, more than one-third of patients were classified as having severe COVID-19. HsTnI and NT-proBNP levels were available for 427 and 414 patients, respectively. The median HsTnI and NT-proBNP levels were 16 (interquartile range [IQR]: 5-57) ng/L and 524 (IQR: 140-2056) pg/mL, respectively. We stratified the patients into three groups by HsTnI level:

Circulation, Volume 150, Issue Suppl_1, Page A4139631-A4139631, November 12, 2024. Background:Several studies have explored the association between sleep duration and cardiovascular outcomes, but the results have been contradictory. Additionally, there are limited studies conducted within the Asian population.Goal:This study aims to assess the relationship between sleep duration and cardiovascular outcomes in the Asian population.Methods:This cross-sectional study used data from a survey of employees at the Electricity Generating Authority of Thailand (EGAT). Baseline demographics, sleep history, and the presence of cardiovascular diseases were collected in 2012. Self-reported usual sleep and wake times were used to calculate sleep duration. Participants were categorized into 3 groups based on sleep duration: short (< 6 hours), normal (6-8 hours), and long ( > 8 hours). Logistic regression analysis was used to assess the association between sleep duration and cardiovascular outcomes, with the normal sleep duration group as a reference. Adjustments were made for variables as shown in the table.Results:Among 1571 participants enrolled, 6%, 77%, and 17% were categorized into the short, normal, and long sleep duration groups, respectively. The mean (SD) age was 69 (4.6) years, and 73% were male, consistent across all groups. The median (IQR) sleep duration was 5 (4.5-5.0) hours, 7 (6.5-8.0) hours, and 9 (8.5-9.5) hours for the short, normal, and long sleep duration groups. Among these three groups, participants in the long sleep duration group had higher levels of HbA1C (p=0.049) and triglyceride (p=0.005), but a lower level of HDL cholesterol (p=0.003). Multiple logistic regression analysis demonstrated that long sleep duration was significantly associated with stroke, with an odd ratio (OR) of 3.25 (95% CI 1.27-8.36), and showed a non-significant trend towards a higher risk of coronary heart disease. We found no significant association between short sleep duration and cardiovascular outcomes.Conclusion:Long sleep duration is associated with an increased risk of cardiovascular diseases, especially stroke. Additional studies with larger sample sizes are needed to investigate the effects of short sleep duration.

Circulation, Volume 150, Issue Suppl_1, Page A4143857-A4143857, November 12, 2024. Background:Circadian patterns of arrhythmias based on time of occurrence have been described in small datasets, but there is little information on the relationship of arrhythmia occurrence to sleep and activity. We sought to quantify the occurrence of arrhythmias detected by long-term (≤14 days) continuous ambulatory ECG monitoring (LTCM) during sleep, wake, and activity.Methods:We performed a retrospective analysis of consecutive patients who underwent LTCM with an FDA cleared device that features an embedded accelerometer (Zio®Monitor, iRhythm Technologies, Inc.; San Francisco CA). This feasibility analysis included nationwide patients for whom LTCM ECG data were processed on a single day (Feb 1, 2024).We applied an AI algorithm previously developed and validated as a wellness feature to classify periods of sleep, activity (≥2mph walking), and inactivity using LTCM accelerometry data. Rhythms were classified by an FDA-cleared deep learning algorithm, confirmed by a cardiographic technician and time-aligned to the algorithm-generated sleep/wake and activity/inactivity labels. Odds ratios (OR) associated with time in arrhythmia for sleep and activity periods were calculated by rhythm type.Results:Analysis included 3,840 patients (58.3% female, age 59.7±19.7 years) monitored for an average 10.5 days (Table 1); patients spent the most time in AF. Rhythms with the highest association with sleep (vs. wake) were pause (OR=2.06; 95% CI 2.00-2.12) and 3rddegree block, (OR=1.81; 95% CI 1.79-1.83). Notably, VT was among the arrhythmias least likely to occur during sleep (OR=0.31; 95% CI 0.30-0.31). Second degree (Mobitz type 2) and third degree block had the highest OR associated with activity.Conclusion:This is the largest study characterizing sleep, wake, and activity of ambulatory arrhythmias — and obtained from only a single day of data. Results demonstrate the feasibility of integrating sleep and activity labeling with LTCM findings and the potential to give context to arrhythmias, such onset or termination during sleep, wake, or exertion.

Circulation, Volume 150, Issue Suppl_1, Page A4143723-A4143723, November 12, 2024. Introduction:Thrombocytosis, sometimes extreme, after acute Kawasaki disease (KD) is common and felt to be pathognomonic of this diagnosis, although has also been reported after multisystem inflammatory syndrome in children (MIS-C), a clinically similar condition. We sought to determine differences in factors associated with thrombocytosis for each condition.Methods:From 01/2020 to 10/2023 across 41 sites in 8 countries from the International KD Registry, 1674 MIS-C and 1290 contemporaneous KD patients with adequate laboratory data were included in the analysis. Age-related cutpoints (derived from the CALIPER Study of normal children/adolescents; AJCP 2020; 154:342) were applied to peak platelet counts to define thrombocytosis (age 647 x109/L; age 1 to 434; age 12 to 371). Associations of demographic, clinical, laboratory and outcome factors with thrombocytosis were determined for each diagnosis group.Results:Thrombocytosis was more prevalent after KD (57%) than MIS-C (49%; p

Circulation, Volume 150, Issue Suppl_1, Page A4146140-A4146140, November 12, 2024. Background:Many medications, electrolyte perturbations, and several diseases can prolong the QTc beyond its 99thpercentile value resulting in acquired QT prolongation (AQTP). In contrast, approximately 1 in 2,000 people have congenital long QT syndrome (LQTS) hallmarked by pathological QT prolongation. Recently, we developed an AI-ECG model to distinguish these two groups, however this model does not elucidate which ECG segments distinguish LQTS from AQTP.Methods:Using the cohort from our previous study, all patients with LQTS evaluated in the Mayo Clinic Genetic Heart Rhythm Clinic and controls were included. Next, every patient/control with ≥1 ECG above age- and sex-specific 99thpercentile for QTc was selected and matched at 1:100 ratio. Subsequently, 5 ML algorithms (logistic regression, Naïve Bayes, random forest, Gradient boosting and XGBoost) were trained using 52 features representing segments of the 12-lead ECG (e.g. wave peak times, amplitudes, areas under wave, duration; 52×12 features). Training and testing sets were spilt at 80:20 ratio and 5-fold cross validation was performed to prevent overfitting. Following analysis, the top 100 features were re-analyzed to refine results.Results:Among >1,600 patients with LQTS, 690 had ≥ 1 ECG with a QTc above the established threshold compared to 28,186 controls. Following age- and sex-matching and splitting, 22,410 (training), and 5,776 (testing) ECGs were used. Of the 5 ML algorithms, XGBoost demonstrated best performance (AUC 0.913, accuracy 0.836, sensitivity 0.857, specificity 0.835) to distinguish LQTS from AQTP. Following filtering for the top 100 features, performance of the algorithm remained high with AUC of 0.912 (accuracy 0.84, sensitivity 0.841, specificity 0.84). The features with the greatest impact on classification output included time from T wave onset to T wave peak (leads V1, V4, V4), QRS interval duration (leads V1, V3, V4, aVR), and amplitude at end of ST segment (aVF).Conclusions:Distinguishing monogenetically driven LQTS from multi-factorial AQTP is critical in clinical practice for proper management, mitigation of offending QT-prolonging factors, and treatment. Building on our previously developed AI-ECG-LQTS ‘mutation detector’, this model identifies some of the elements within the ‘black box’ that distinguish an ECG and QTc stemming from a patient with LQTS compared to a similar prolonged QTc value that is arising due to non-genetic, acquired QT-prolonging factors.

Circulation, Volume 150, Issue Suppl_1, Page A4135327-A4135327, November 12, 2024. Background:With the aging population, the prevalence of malignancies in patients undergoing percutaneous coronary intervention (PCI) is increasing. Active malignancy is increasingly recognized as a significant contributor to high bleeding risks. In cases where anticoagulant (AC) therapy is required, it becomes crucial to determine which is the optimal choice for cancer patients, direct oral anticoagulants (DOACs) or warfarin. The aim of this study was to investigate long-term bleeding events in patients with malignancy undergoing PCI.Methods:CLIDAS (Clinical Deep Data Accumulation System) is a multicenter database with 7 tertiary medical hospitals in Japan. This retrospective analysis using CLIDAS database included 6838 patients who underwent PCI during April 2014 and March 2020 and also who have completed 3-year follow-up were divided into two groups; No malignancy group (n=6155) and malignancy group (n=683). Malignancy was defined as patients with treatment history of malignancy. Furthermore, these patients were categorized into six groups based on the presence of malignancy and the type of AC therapy;1)No malignancy without AC (n=5369),2)No malignancy with DOAC (n=294),3)No malignancy with warfarin (n=492),4)Malignancy without AC (n=586),5)Malignancy with DOAC (n=44), and6)Malignancy with warfarin (n=53). The primary outcome was the incidence of bleeding events, defined according to the Global Use of Streptokinase and t-PA for Occluded Coronary Arteries classification of moderate and severe bleeding.Results:During the 3-year follow-up period, 260 (3.8%) patients experienced major bleeding events after PCI. Among these patients, 180 (3.4%) were in group 1, 9 (3.1%) in group 2, 33 (6.7%) in group 3, 27 (4.6%) in group 4, 2 (4.5%) in group 5, and 9 (17.0%) in group 6. Multivariate Cox regression analysis showed that patients in the malignancy group had a significantly higher rate of bleeding events (HR, 1.50; 95% CI, 1.03-2.18). Furthermore, only the malignancy with warfarin group showed a significantly higher rate of bleeding events compared to the no malignancy without AC group (HR, 4.03; 95% CI, 1.94-8.37).Conclusions:Patients with malignancies receiving warfarin were associated with a higher risk of bleeding events. DOACs may be a safer alternative to warfarin in reducing bleeding risk in this population.

Circulation, Volume 150, Issue Suppl_1, Page A4114293-A4114293, November 12, 2024. Background:Stent length has been considered an important predictor of adverse events in stable patients undergoing percutaneous coronary intervention (PCI). However, there are few data in acute myocardial infarction (AMI) patients treated with very long drug-eluting stents (DES). We conducted this study to evaluate the impact of stent length on the long-term clinical outcomes.Method:The study included a total of 9,021 AMI patients who underwent PCI with 2ndgeneration DESs. The patients were categorized into 3 groups according to the stent length: group A (

Circulation, Volume 150, Issue Suppl_1, Page A4139675-A4139675, November 12, 2024. Background:The net benefit of aspirin cessation in older adults remains uncertain. This study aimed to use observational data to emulate a randomized trial of aspirin cessation versus continuation in older adults without cardiovascular disease (CVD).Methods:Post-hoc analysis using a target trial emulation framework (Table 1) applied to the immediate post-trial period (2017-2021) of a study of low-dose aspirin initiation in 19,114 adults aged 70 years and older (ASPREE; NCT01038583). Participants from Australia and US were included if they were free of CVD at the start of the post-trial intervention period (time zero, T0) and had been taking open-label or randomized aspirin immediately before T0 (Fig 1A). The two groups in the target trial were: aspirin cessation (participants who were taking randomized aspirin immediately before T0; assumed to have stopped at T0 as instructed) versus aspirin continuation (participants on open-label aspirin at T0 regardless of their randomized treatment; assumed to have continued at T0). The outcomes after T0 were incident CVD, major adverse cardiovascular events (MACE), all-cause mortality, and major bleeding during 3, 6, and 12 months (short-term), and 48 months (long-term) follow-up. Hazard ratios (HRs) comparing aspirin cessation to continuation were estimated from propensity-score (PS) adjusted Cox proportional-hazards regression models.Results:We included 6,103 CVD-free participants (cessation: 5,427, continuation: 676). Participant selection flow chart is presented inFig 1B. Over both short- and long-term follow-up, aspirin cessation versus continuation was not associated with elevated risk of CVD, MACE and all-cause mortality (HRs, at 3 and 48 months respectively were, 1.23 and 0.73 for CVD; 1.11 and 0.84 for MACE; 0.23 and 0.79 for all-cause mortality, p >0.05) but cessation had a reduced risk of incident major bleeding events (HRs at 3 and 48 months, 0.16 and 0.63, p