Roberta Rossini1, Annamaria Iorio2, Roberto Pozzi2, Matteo Bianco2, Giuseppe Musumeci2, Sergio Leonardi2, Corrado Lettieri2, Irene Bossi2, Paola Colombo2, Stefano Rigattieri2, Cinzia Dossena2, Angelo Anzuini2, Davide Capodanno2, Michele Senni2, Dominick J Angiolillo2. 1. From the Dipartimento Cardiovascolare, ASST Papa Giovanni XXIII, Bergamo, Italy (R.R., A.I., G.M., M.S.); Division of Cardiology, A.O.U San Luigi Gonzaga, Orbassano, Torino, Italy (R.P., M.B.); IRCCS Fondazione Policlinico S. Matteo, Pavia, Italy (S.L.); Divisione di Cardiologia, Ospedale Carlo Poma, Mantova, Italy (C.L.); Cardiologia 1 Emodinamica, Dipartimento Cardiovascolare, ASST Niguarda Grande Ospedale Metropolitano, Milano, Italy (I.B., P.C.); U.O. Emodinamica, Ospedale Sandro Pertini, Roma, Italy (S.R.); Università degli Studi di Pavia, Italy (C.D.); Unità operativa di Cardiologia, Humanitas Mater Domini, Castellanza (Varese), Italy (A.A.); Cardio-Thoracic-Vascular Department, Ferrarotto Hospital, University of Catania, Italy (D.C.); and Division of Cardiology, University of Florida College of Medicine, Jacksonville (D.J.A.). roberta.rossini2@gmail.com. 2. From the Dipartimento Cardiovascolare, ASST Papa Giovanni XXIII, Bergamo, Italy (R.R., A.I., G.M., M.S.); Division of Cardiology, A.O.U San Luigi Gonzaga, Orbassano, Torino, Italy (R.P., M.B.); IRCCS Fondazione Policlinico S. Matteo, Pavia, Italy (S.L.); Divisione di Cardiologia, Ospedale Carlo Poma, Mantova, Italy (C.L.); Cardiologia 1 Emodinamica, Dipartimento Cardiovascolare, ASST Niguarda Grande Ospedale Metropolitano, Milano, Italy (I.B., P.C.); U.O. Emodinamica, Ospedale Sandro Pertini, Roma, Italy (S.R.); Università degli Studi di Pavia, Italy (C.D.); Unità operativa di Cardiologia, Humanitas Mater Domini, Castellanza (Varese), Italy (A.A.); Cardio-Thoracic-Vascular Department, Ferrarotto Hospital, University of Catania, Italy (D.C.); and Division of Cardiology, University of Florida College of Medicine, Jacksonville (D.J.A.).
Abstract
BACKGROUND: There are limited data on aspirin (ASA) desensitization for patients with coronary artery disease. The aim of the present study was to assess the safety and efficacy of a standard rapid desensitization protocol in patients with ASA sensitivity undergoing coronary angiography. METHODS AND RESULTS: This is a prospective, multicenter, observational study including 7 Italian centers including patients with a history of ASA sensitivity undergoing coronary angiography with intent to undergo percutaneous coronary intervention. A total of 330 patients with history of ASA sensitivity with known/suspected stable coronary artery disease or presenting with an acute coronary syndrome, including ST-segment-elevation myocardial infarction were enrolled. Adverse effects to aspirin included urticaria (n=177, 53.6%), angioedema (n=69, 20.9%), asthma (n=65, 19.7%), and anaphylactic reaction (n=19, 5.8%). Among patients with urticaria/angioedema, 13 patients (3.9%) had a history of idiopathic chronic urticaria. All patients underwent a rapid ASA (5.5 hours) desensitization procedure. The desensitization procedure was performed before cardiac catheterization in all patients, except for those (n=78, 23.6%) presenting with ST-segment-elevation myocardial infarction who underwent the desensitization after primary percutaneous coronary intervention. Percutaneous coronary intervention was performed in 235 patients (71%) of the overall study population. The desensitization procedure was successful in 315 patients (95.4%) and in all patients with a history of anaphylactic reaction. Among the 15 patients (4.6%) who did not successfully respond to the desensitization protocol, adverse reactions were minor and responded to treatment with corticosteroids and antihistamines. Among patients with successful in-hospital ASA desensitization, 253 patients (80.3%) continued ASA for at least 12 months. Discontinuation of ASA in the 62 patients (19.7%) who had responded to the desensitization protocol was because of medical decision and not because of hypersensitivity reactions. CONCLUSIONS: A standard rapid desensitization protocol is safe and effective across a broad spectrum of patients, irrespective of the type of aspirin sensitivity manifestation, with indications to undergo coronary angiography with intent to perform percutaneous coronary intervention. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT02848339.
BACKGROUND: There are limited data on aspirin (ASA) desensitization for patients with coronary artery disease. The aim of the present study was to assess the safety and efficacy of a standard rapid desensitization protocol in patients with ASA sensitivity undergoing coronary angiography. METHODS AND RESULTS: This is a prospective, multicenter, observational study including 7 Italian centers including patients with a history of ASA sensitivity undergoing coronary angiography with intent to undergo percutaneous coronary intervention. A total of 330 patients with history of ASA sensitivity with known/suspected stable coronary artery disease or presenting with an acute coronary syndrome, including ST-segment-elevation myocardial infarction were enrolled. Adverse effects to aspirin included urticaria (n=177, 53.6%), angioedema (n=69, 20.9%), asthma (n=65, 19.7%), and anaphylactic reaction (n=19, 5.8%). Among patients with urticaria/angioedema, 13 patients (3.9%) had a history of idiopathic chronic urticaria. All patients underwent a rapid ASA (5.5 hours) desensitization procedure. The desensitization procedure was performed before cardiac catheterization in all patients, except for those (n=78, 23.6%) presenting with ST-segment-elevation myocardial infarction who underwent the desensitization after primary percutaneous coronary intervention. Percutaneous coronary intervention was performed in 235 patients (71%) of the overall study population. The desensitization procedure was successful in 315 patients (95.4%) and in all patients with a history of anaphylactic reaction. Among the 15 patients (4.6%) who did not successfully respond to the desensitization protocol, adverse reactions were minor and responded to treatment with corticosteroids and antihistamines. Among patients with successful in-hospital ASA desensitization, 253 patients (80.3%) continued ASA for at least 12 months. Discontinuation of ASA in the 62 patients (19.7%) who had responded to the desensitization protocol was because of medical decision and not because of hypersensitivity reactions. CONCLUSIONS: A standard rapid desensitization protocol is safe and effective across a broad spectrum of patients, irrespective of the type of aspirin sensitivity manifestation, with indications to undergo coronary angiography with intent to perform percutaneous coronary intervention. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT02848339.
Authors: Zuhui Cheong; Cheryl Ying Lin Tan; Chuan Poh Lim; Jie Lin Soong; Chiara Jia Min Chong; Adrian Kwok Wai Chan Journal: Asia Pac Allergy Date: 2021-04-27