Efficacy and Safety of Aspirin in Patients With Chronic Coronary Syndromes Without Revascularization

Study Overview
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Brief Summary
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The purpose of this study is to evaluate the efficacy and safety aspirin in patients with chronic coronary syndromes without revascularization.

Detailed Description
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Aspirin for secondary prevention in the acute phase of acute coronary syndromes has been established. Although it is still disputable about the duration, there is also a consensus for antiplatelet therapy in patients after percutaneous coronary revascularization. On the other hand, several large randomized clinical trials (RCTs) have shown that aspirin treatment for primary prevention of cardiovascular events increases bleeding events and does not provide net clinical benefit.Patient with chronic coronary syndromes (CCS) but not eligible for revascularization do not belong to any of these categories and there is no evidence on the efficacy of aspirin in this population. Therefore, we designed a multicenter, randomized, open-label study to evaluate the efficacy and safety of aspirin in patients with CCS who are not eligible for revascularization.

Official Title
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Efficacy and Safety of Aspirin in Patients With Chronic Coronary Syndromes Without Revascularization

Conditions
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Stable Angina Pectoris, Coronary Artery Disease, Ischemic Heart Disease

Intervention / Treatment
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* Drug: Aspirin
* Drug: No aspirin


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients with chronic coronary syndromes with ≧50% diameter stenosis in one or more major coronary vessels/major branches on coronary CT or coronary angiography but not eligible for coronary revascularization Patients for whom consent can be obtained Exclusion Criteria: Patients with history of acute coronary syndromes (ACS) Patients with history of percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) Patients with left main trunk stenosis (≥50%) Patients for whom aspirin administration is mandatory Patients undergoing antithrombotic therapy other than aspirin Patients with atrial fibrillation Patients with history of stroke within six months Patients scheduled for major surgical procedures that will require aspirin discontinuation Patients with contraindication of aspirin Patients expected to have a prognosis of 1 year or less due to comorbidities Women of child-bearing potential or women who have a positive pregnancy test at enrolment or randomization Patients who are judged by attending physicians to be inappropriate to participate in this study

Ages Eligible for Study
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Minimum Age: 20 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Aspirin<br>Aspirin 100 mg/day | Drug: Aspirin<br>* Aspirin 100 mg/day<br>|
| Active Comparator: No Aspirin<br>No Aspirin | Drug: No aspirin<br>* No aspirin administered<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Composite cardiovascular events | Composite of all-cause death, myocardial infarction, ischemic stroke, coronary revascularization, peripheral revascularization, or critical limb ischemia | 5 years | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| All-cause death | As classified by Academic Research Consortium (ARC) (Circulation. 2007;115:2344-2351). Cardiac Death: Any death due to proximate cardiac cause, unwitnessed death and death of unknown cause, all procedure related deaths including those related to concomitant treatment. All deaths are considered cardiac unless an unequivocal non-cardiac cause can be established. Specifically, any unexpected death even in subjects with coexisting potentially fatal non-cardiac disease should be classified as cardiac. Vascular Death: Death due to non-coronary vascular causes such as cerebrovascular disease, pulmonary embolism, ruptured aortic aneurysm, dissecting aneurysm, or other vascular cause. Non-cardiovascular Death: Any death not covered by the above definitions such as death caused by infection, malignancy, sepsis, pulmonary causes, accident, suicide or trauma. Cancer related death: death from cancer cause | 5 years | 
| Myocardial infarction | As classified by Academic Research Consortium (ARC): However, the sensitivity is too high for the evaluation with Troponin of the peri-procedural MI, thus CKMB will be used. | 5 years | 
| Ischemic stroke | Ischemic stroke is defined as acute onset of a neurological deficit that persists for at least 24 hours and is the result of a disturbance of the cerebral circulation due to ischemia. Deficits that last ≤ 24 hours are due to transient ischemic neurological attack and are not classified in this category. | 5 years | 
| Coronary revascularization | The revascularization that meets the following criteria is considered as clinically indicated revascularization. Presence/absence of clinical findings is judged by the operator of the procedure before the revascularization. | 5 years | 
| Peripheral revascularization | The revascularization that meets the following criteria is considered as clinically indicated revascularization. Presence/absence of clinical findings is judged by the operator of the procedure before the revascularization. | 5 years | 
| Critical limb ischemia | Critical limb ischemia is defined by chronic ischemic pain at rest and/or presence of ischemic skin lesions (gangrene or ulcerations). | 5 years | 
| Cardiovascular death | Cardiac Death: Any death due to proximate cardiac cause (e.g. myocardial infarction [MI], low-output failure, fatal arrhythmia), unwitnessed death and death of unknown cause, all procedure related deaths including those related to concomitant treatment. All deaths are considered cardiac unless an unequivocal non-cardiac cause can be established. Specifically, any unexpected death even in subjects with coexisting potentially fatal non-cardiac disease (e.g. cancer, infection) should be classified as cardiac. Vascular Death: Death due to non-coronary vascular causes such as cerebrovascular disease, pulmonary embolism, ruptured aortic aneurysm, dissecting aneurysm, or other vascular cause. | 5 years | 
| Major bleeding | Bleeding/Hemorrhagic Complications will be evaluated using the Bleeding Academic Research Consortium (BARC) definition. Major bleeding is defined as BARC 3 or 5. | 5 years | 
| Hospital admission for heart failure | An unplanned hospitalization with heart failure. Heart failure is defined by the modified Framingham criteria as follow: [Major Criteria] 1) Paroxysmal nocturnal dyspnea 2) Orthopnea 3) Neck-vein distension 4) Rales 5) Acute pulmonary edema [Minor Criteria] Ankle edema Dyspnea on exertion Pleural effusion Tachycardia (HR ≧ 120/min) * For establishing a definite diagnosis of heart failure, 2 Major criteria or 1 major and 2 minor criteria must be present concurrently | 5 years | 
| Cancer incidence | Non-metastatic cancer (not present prior to randomization) Metastatic cancer (cancer that was metastatic at presentation, metastasis of a non-metastatic cancer presents at baseline, or blood cancer) Non-melanoma skin cancer was excluded cancer end points. | 5 years | 
| Cancer death | Cancer death is defined as death from cancer cause. | 5 years | 
| Composite of all-cause mortality, myocardial infarction, ischemic stroke, coronary revascularization, lower extremity revascularization, critical lower extremity ischemia, major bleeding, hospital admission for heart failure, cancer death | Composite of all-cause mortality, myocardial infarction, ischemic stroke, coronary revascularization, lower extremity revascularization, critical lower extremity ischemia, major bleeding, hospital admission for heart failure, cancer death | 5 years | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Chronic Coronary Syndrome, Aspirin