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Does aspirin use prevent acute coronary syndrome in patients with pneumonia: multicenter prospective randomized trial

Oz, Fahrettina; Gul, Sulec; Kaya, Mehmet G.b; Yazici, Mehmeth; Bulut, Ismetd; Elitok, Alia; Ersin, Gunaye; Abakay, Ozlemf; Akkoyun, Cayan D.g; Oncul, Aytaca; Cetinkaya, Erdoganc; Gibson, Michael C.i; Oflaz, Huseyina

doi: 10.1097/MCA.0b013e32835d7610
Therapy and Prevention

Objectives The aim of this study was to test the hypothesis that aspirin would reduce the risk for acute coronary syndromes (ACSs) in patients with pneumonia.

Backgrounds Pooled data suggest that pneumonia may trigger an ACS as a result of inflammatory reactions and the prothrombotic changes in patients with pneumonia. Hypothetically considering its antiaggregating and anti-inflammatory effects, aspirin might also be beneficial for the primary prevention of ACS in patients with pneumonia.

Methods One hundred and eighty-five patients with pneumonia who had more than one risk factor for cardiovascular disease were randomized to an aspirin group (n=91) or a control group (n=94). The patients in the aspirin group received 300 mg of aspirin daily for 1 month. ECGs were recorded on admission and 48 h and 30 days after admission to assess silent ischemia. The level of high-sensitivity cardiac troponin T was measured on admission and 48 h after admission. The primary endpoint was the development of ACS within 1 month. The secondary endpoints included cardiovascular death and death from any cause within 1 month.

Results The χ 2-test showed that the rates of ACS at 1 month were 1.1% (n=1) in the aspirin group and 10.6% (n=10) in the control group (relative risk, 0.103; 95% confidence interval 0.005–0.746; P=0.015). Aspirin therapy was associated with a 9% absolute reduction in the risk for ACS. There was no significant decrease in the risk of death from any cause (P=0.151), but the aspirin group had a decreased risk of cardiovascular death (risk reduction: 0.04, P=0.044).

Conclusion This randomized open-label study shows that acetyl salicylic acid is beneficial in the reduction of ACS and cardiovascular mortality among patients with pneumonia.

aDepartment of Cardiology, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey

bDepartment of Cardiology, Erciyes University School of Medicine, Kayseri, Turkey

cDepartment of Chest Diseases, Yedikule Chest Diseases and Thoracic Surgery Education and Research Hospital

dDepartment of Chest Diseases, Division of Allergy, Sureyyapasa Chest Diseases and Thoracic Surgery Education and Research Hospital, Istanbul

eDepartment of Chest Diseases, Afyon Kocatepe University School of Medicine, Afyon

fDepartment of Chest Diseases, Dicle University School of Medicine, Diyarbakir

gDepartment of Cardiology, Namik Kemal University School of Medicine, Tekirdag

hDepartment of Cardiology, Abant Izzet Baysal Univesity School of Medicine, Bolu, Turkey

iBeth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA

Correspondence to Fahrettin Oz, MD, Department of Cardiology, Istanbul School of Medicine, Istanbul University, 34036 Fatih/Istanbul, Turkey Tel: +90 212 414 20 00 x31422; fax: +90 212 534 07 68; e-mail:

Received October 25, 2012

Accepted November 25, 2012

© 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins