Acetylsalicylic acid use is associated with reduced risk of out-of-hospital cardiac arrest in the general population: Real-world data from a population-based study
ESCAPE-NET Investigators
(2022) PLoS One, volume 17, issue 6, pp. 1 - 12
(Article)
Abstract
AIM: Activated blood platelet products facilitate myocardial intracellular Ca2+ overload, thereby provoking afterdepolarizations and increasing susceptibility of ischemic myocardium to ventricular fibrillation (VF). These effects are counteracted in vitro by acetylsalicylic acid (ASA), but no prior study investigated whether ASA is associated with decreased out-of-hospital cardiac arrest (OHCA) risk on
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a population level. Therefore, we studied whether ASA and other antiplatelet drugs (carbasalate calcium, clopidogrel) are associated with decreased risk of OHCA. METHODS: We conducted a population-based case-control study among individuals (772 OHCA-cases with documented VT/VF, 2444 non-OHCA-controls) who had used antiplatelet drugs in the year before index-date (OHCA-date), and studied the association between current antiplatelet drug use and OHCA-risk with multivariable logistic regression analysis. RESULTS: ASA use was associated with reduced OHCA-risk (adjusted odds ratio (ORadj) 0.6 [0.5-0.8]), and more so in women (ORadj 0.3 [0.2-0.6]) than in men (ORadj 0.7 [0.5-0.95], Pinteraction 0.021). Carbasalate calcium was associated with decreased OHCA-risk in women (ORadj 0.5 [0.3-0.9]), but not in men (ORadj 1.3 [0.96-1.7], Pinteraction 0.005). Clopidogrel was not associated with reduction in OHCA-risk. Risk reduction associated with ASA in patients with OHCA was similar in the presence of acute myocardial infarction (AMI) (ORadj 0.6 [0.4-0.9]) and in the absence of AMI (ORadj 0.7 [0.4-1.2]). CONCLUSION: ASA use was associated with reduced OHCA-risk in both sexes, and more so in women, while carbasalate calcium only protected women. Clopidogrel was not associated with reduced OHCA-risk.
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Keywords: Aspirin/therapeutic use, Calcium, Cardiopulmonary Resuscitation, Case-Control Studies, Female, Humans, Male, Myocardial Infarction/complications, Out-of-Hospital Cardiac Arrest, Platelet Aggregation Inhibitors/therapeutic use, Ventricular Fibrillation, General
ISSN: 1932-6203
Publisher: Public Library of Science
Note: Funding Information: This project has received funding from the European Union’s Horizon 2020 research and innovation programme under acronym ESCAPE-NET, registered under grant agreement No 733381 (T.E.E., M.T.B., H.L.T. URL: https://ec.europa.eu/ programmes/horizon2020/en), and the Dutch Heart Foundation (CVON2017-15 RESCUED and CVON2018-30 Predict-2; M.T.B., H.L.T. URL: https://www.vo.eu/home/about-vo/sponsoring/ hartstichting-the-dutch-heart-foundation/). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The authors greatly appreciate the contributions of Paulien Homma, Remy Stieglis and Sandra de Haas for data management of the ARREST registry, and are greatly indebted to all participating EMS dispatch centers (Amsterdam, Haarlem and Alkmaar), regional ambulance services (Ambulance Amsterdam, GGD Kennemerland, Witte Kruis and Veiligheidsregio Noord-Holland Noord Ambulancezorg), fire brigades, and police departments in the study region for their contribution and support. The authors would also like to thank PHARMO Database Network, Stichting Farmaceutische Kerngetallen and the pharmacists for the participation in this study. TEE, MTB, PCS and HLT take full responsibility for the integrity of the data and the accuracy of the data analysis. ESCAPE-NET (https://escape-net.eu/) consortium members are Hanno L. Tan, Marieke T. Blom, Talip E. Eroglu, Irene G.M. van Valkengoed, Aeilko H. Zwinderman, Elisabeth M. Lodder, Michael W.T. Tanck, Marcel M.A.M. Mannens, Peter Henneman, Laura H.P.I. van Dongen, Marieke A.R. Bak, Connie R. Bezzina, Dick L. Willems, Dominic S. Zimmerman, Lixia Jia, Ben P. van Nieuwenhuizen, Iris Oving, Remy Stieglis, Mette M. Ekkel, Vera G.M. van Eeden, Emma C. Linssen, Robin L.A. Smits, Jacob Tfelt-Hansen, Gunnar Gislason, Fredrik Folke, Charlotte Glinge, Nertila Zylyftari, Simon Mathis Konig, Xavier Jouven, Jean-Philippe Empana, Mattias Ringh, Martin Jonsson, Ellinor Berglund, Peter J. Schwartz, Gaetano M. de Ferrari, Lia Crotti, Veronica Dusi, Giuseppe Ristagno, Francesca Fumagalli, Simone Savastano, Enrico Baldi, Petra J.M. Elders, Peter P. Harms, Sabrina J.G.C. Welten, Anatolij Truhlar. Publisher Copyright: Copyright: © 2022 Eroglu et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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