Aspirin in Subclinical Coronary Artery Disease: A Pilot Randomised Controlled Trial

Inclusion Criteria:

1. Documented coronary atherosclerosis, as defined by one of the following criteria:

   1. Coronary artery calcium (CAC) score \> 0;
   2. 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;
   3. 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.
2. Willing and able to provide informed consent and comply with study procedures

Exclusion Criteria:

1. History of myocardial infarction (MI), coronary revascularization, stroke, transient ischemic attack (TIA), or peripheral arterial revascularization procedure;
2. Current prescription or clear indication for aspirin, low-molecular-weight heparin (LMWH), direct oral anticoagulants, or any other antithrombotic medication;
3. Clear contraindication to aspirin;
4. History of significant bleeding within the past year;
5. Severe illness with limited life expectancy (i.e., \<5 years);
6. Any condition that, in the investigator's judgment, would make participation unsafe for the patient.