Aspirin in Subclinical Coronary Artery Disease: A Pilot Randomised Controlled Trial
For patients and families
In plain language
An automatic summary of structured registry data. It is an orientation aid, not a substitute for the official protocol or a physician assessment.
- What is being studied
- The protocol lists: Prescription of Aspirin, No prescription.
- Who it may be relevant to
- Registry conditions: Coronary Artery Disease, Subclinical Atherosclerotic Cardiovascular Disease. Basic parameters: from 40 years · All.
- What needs checking
- Age, condition and sex are only basic indicators. Prior treatment, laboratory values and other mandatory requirements appear in the eligibility criteria below.
- Where it takes place
- Canada
- Next step
- Save the trial, show it to the treating physician, and confirm current recruitment with the study center. Costs, documents and travel →
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Overview
In patients with subclinical coronary artery disease, the ASCAD-P study aims to assess the feasibility of a larger phase 3 pragmatic randomized controlled trial comparing prescription versus no prescription of low-dose aspirin in routine clinical practice.
Detailed description
Cardiovascular disease remains the leading cause of mortality worldwide. Recent large randomized trials have demonstrated limited net clinical benefit of aspirin in unselected primary prevention populations, leading to guideline recommendations against its systematic routine use for cardiovascular protection.
Patients with subclinical coronary artery disease represent a high-risk subgroup. These individuals have documented coronary artery disease but have not experienced overt cardiovascular events or undergone revascularization. Observational data suggest that this population carries a substantially increased risk of myocardial infarction compared with individuals without coronary atherosclerosis. However, the benefit-risk balance of aspirin in this intermediate-risk group remains uncertain
Primary Objective:
To evaluate the recruitment rate of a pilot randomized trial comparing low-dose aspirin prescription versus no prescription.
Secondary Objectives
To evaluate key feasibility metrics, including:
* The proportion of eligible patients who are randomized; * Adherence and persistence to the assigned intervention at 12 months; * The proportion of patients who do not complete the 12-month follow-up; * Barriers to recruitment, adherence, and retention.
Exploratory Objectives:
To explore clinical outcomes at 12 months, including:
* The incidence of clinically significant bleeding events (BARC type 2, 3, or 5) and bleeding site; * The incidence of major adverse cardiovascular events (MACE), defined as a composite of all-cause mortality, non-fatal myocardial infarction, non-fatal stroke, or coronary revascularization; * Individual components of the composite endpoint; * Cardiovascular mortality; * Adverse Events and Serious Adverse Events.
Interventions
- Drug Prescription of Aspirin
Aspirin 81 mg orally once daily - Drug No prescription
No prescription of aspirin 81 mg orally once daily
Primary outcome measures
- Monthly Recruitment Rate [Time frame: 12 months following study enrollment initiation]
Secondary outcome measures (5)
- Proportion of Eligible Patients Randomized [Time frame: 12 months following study enrollment initiation]
- Intervention Adherence [Time frame: From randomization to the end of follow-up (12 months)]
- Intervention Persistence [Time frame: From randomization to end of follow-up (12 months)]
- Proportion of Patients Lost to Follow-up [Time frame: End of follow-up (12 months)]
- Barriers to Recruitment, Adherence, and Patient Retention [Time frame: From recruitment to the end of follow-up (12 months)]
Eligibility criteria
Inclusion criteria
- Documented coronary atherosclerosis, as defined by one of the following criteria:
- Coronary artery calcium (CAC) score > 0;
- Cardiac CT angiography (CCTA) / CoroScan: lesions <70% in the right coronary (RCA), left anterior descending (LAD), and circumflex (Cx) arteries or their branches, and <50% in the left main coronary artery;
- Coronary angiography: lesions <70% in the right coronary (RCA), left anterior descending (LAD), and circumflex (Cx) arteries or their branches, and <50% in the left main coronary artery; if performed, physiological coronary assessments (FFR, dPR, iFR, etc.) and intracoronary imaging (IVUS or OCT) must be negative for significant disease.
- Willing and able to provide informed consent and comply with study procedures
Exclusion criteria
- History of myocardial infarction (MI), coronary revascularization, stroke, transient ischemic attack (TIA), or peripheral arterial revascularization procedure;
- Current prescription or clear indication for aspirin, low-molecular-weight heparin (LMWH), direct oral anticoagulants, or any other antithrombotic medication;
- Clear contraindication to aspirin;
- History of significant bleeding within the past year;
- Severe illness with limited life expectancy (i.e., <5 years);
- Any condition that, in the investigator's judgment, would make participation unsafe for the patient.
Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.
Healthy volunteers: No
Study design
- Allocation
- Randomized
- Model
- Parallel assignment
- Masking
- Open label
- Primary purpose
- Prevention
Study locations
Canada · 1 center
- Montreal Heart Institute — Montreal
Identifiers
NCT: NCT07524335 · 2026-3694