Research from the current ACC shows that despite guidelines recommending aspirin as the first choice for patients before angioplasty, a significant number of patients have a significantly higher mortality rate during hospitalization due to non-use of this drug before surgery. The ACC/AHA guidelines recommend aspirin as the first choice before angioplasty, with good antiplatelet activity and a reduction in cardiac events. A total of 65,175 patients who underwent angioplasty and stenting from 42 hospitals and were hospitalized from February 2010 to November 2011 were included in the study. Of these patients, 4,640 (7.1%) did not take aspirin 24 hours before PCI, and approximately 90% of them had no contraindications to taking aspirin. Patients with previous gastrointestinal bleeding were not recorded as using aspirin, although this was not a contraindication to aspirin use prior to PCI. Dr. MohamadKenaan, who was the lead investigator of the study, concluded that: the study was not to determine the direct causal effect of aspirin on PCI outcomes, but to clarify the relationship between aspirin and poor prognosis. Moreover, the highlight of this study was the failure to use aspirin before PCI despite the fact that many patients did not have contraindications to taking aspirin. This was the case even within an institution that was an active participant in a continuous quality improvement program. The in-hospital mortality rate in the pre-procedure no-aspirin group was 3.9%, significantly higher than in the aspirin group (1.2%), even after adjusting for bias, with mortality rates of 3.9% and 2.8% for the two groups, and strokes of 0.5% and 0.1%, respectively. Such results were the same in subgroups, including sex, age, and type of coronary heart disease and diabetes. The only exception was cardiogenic shock. In contrast, there was no significant difference in bleeding, need for blood transfusion, or impairment of renal function due to angiography. In addition, the study also analyzed the length of hospital stay, bleeding in other subgroups. However, the results of long-term follow-up after discharge were not included. According to Dr. Kenaan, this study shows that not using aspirin before PCI is strongly associated with poor prognosis, including in-hospital mortality. This suggests that poor adherence to guidelines leads to poor prognosis.