Impact of aspirin use on clinical outcomes in patients with vasospastic angina: a systematic review and meta-analysis

OBJECTIVES: The use of aspirin to prevent cardiovascular disease in vasospastic angina (VSA) patients without significant stenosis has yet to be investigated. This study aimed to investigate the efficacy of aspirin use among VSA patients. DESIGN: Systematic review and meta-analysis. DATA SOURCES: PubMed, Web of Science and Cochrane Central Register of Controlled Trials were searched for relevant information prior to October 2020. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Aspirin use versus no aspirin use (placebo or no treatment) among VSA patients without significant stenosis. DATA EXTRACTION AND SYNTHESIS: Two investigators extracted the study data. ORs and 95% CIs were calculated and graphed as forest plots. The Newcastle-Ottawa Quality Assessment Scale tool and Begg’s funnel plot were used to assess risk of bias. RESULTS: Four propensity-matched cohorts, one retrospective analysis and one prospective multicentre cohort, in total comprising 3661 patients (aspirin use group, n=1695; no aspirin use group, n=1966) were included in this meta-analysis. Aspirin use and the incidence of major cardiovascular adverse events with follow-up of 1–5 years were not significantly correlated (combined OR=0.90, 95% CI: 0.55 to 1.68, p=0.829, I(2)=82.2%; subgroup analysis: OR=1.09, 95% CI: 0.81 to 1.47, I(2)=0%). No significant difference was found between aspirin use and the incidence of myocardial infarction (OR=0.62, 95% CI: 0.09 to 4.36, p=0.615, I(2)=73.8%) or cardiac death (OR=1.73, 95% CI: 0.61 to 4.94, p=0.444, I(2)=0%) during follow-up. CONCLUSION: Aspirin use may not reduce the risk of future cardiovascular events in VSA patients without significant stenosis. PROSPERO REGISTRATION NUMBER: CRD42020214891.