An Aspirin-Free Strategy for Immediate Treatment Following Complex Percutaneous Coronary Intervention

Ko Yamamoto,Masahiro Natsuaki,Hirotoshi Watanabe,Takeshi Morimoto,Yuki Obayashi,Ryusuke Nishikawa,Kenji Ando,Satoru Suwa,Tsuyoshi Isawa,Hiroyuki Takenaka,Tetsuya Ishikawa,Toshihiro Tamura,Kando Kawahatsu,Fujio Hayashi,Masaharu Akao,Takeshi Serikawa,Hiroyoshi Mori,Takayuki Kawamura,Arata Hagikura,Naoki Shibata,Koh Ono,Takeshi Kimura,Tsuyoshi Isawa,Kohei Wakabayashi,Yuko Onishi,Kiyoshi Hibi,Kazuya Kawai,Ruka Yoshida,Hiroshi Suzuki,Gaku Nakazawa,Takanori Kusuyama,Itsuro Morishima,Hideo Tokuyama,Hiroki Sakamoto,Takanari Fujita,Mamoru Nanasato,Hideki Okayama,Masaharu Akao,Kazushige Kadota,Yoshiki Hata,Yoshihiro J Akashi,Shunzo Matsuoka,Hiroyuki Tanaka,Minoru Yamada,Tetsuzo Wakatsuki,Yoichi Nozaki,Yoshio Kobayashi,Ryuichi Kato,Yuji Ikari,Tairo Kurita,Kazuaki Kaitani,Atsuhiko Sugimoto,Nobuhiko Ogata,Takafumi Yokomatsu,Hiroki Uehara,Tatsuki Doijiri,Ken Kozuma,Yasunori Nishida,Junichi Yamaguchi,Yoshihiro Morino,Takashi Tanigawa,Yukiko Nakano,Noriko Makiguchi,Toshiyuki Noda,Nobuo Shiode,Koji Abe,Shichiro Abe,Isao Tabuchi,Shozo Ishihara,Makoto Kinoshita,Motoaki Higuchi,Tomofumi Takaya,Shin-Ichiro Miura,Yoshinori Tsubakimoto,Kenichi Tsujita,Koji Kumagai,Kengo Tanabe,Moriaki Inoko,Takuo Nakagami,Hirofumi Tomita,Masatsugu Nakano,Kazuhiko Yumoto,Takatoshi Wakeyama,Takeo Kaneko,Masayuki Doi

doi:10.1016/j.jcin.2024.03.017

Abstract

BackgroundThere was no study evaluating the effects of an aspirin-free strategy in patients undergoing complex percutaneous coronary intervention (PCI). ObjectivesThe authors aimed to evaluate the efficacy and safety of an aspirin-free strategy in patients undergoing complex PCI. MethodsWe conducted the prespecified subgroup analysis based on complex PCI in the STOPDAPT-3 (ShorT and OPtimal duration of Dual AntiPlatelet Therapy after everolimus-eluting cobalt-chromium stent-3), which randomly compared low-dose prasugrel (3.75 mg/d) monotherapy to dual antiplatelet therapy (DAPT) with low-dose prasugrel and aspirin in patients with acute coronary syndrome or high bleeding risk. Complex PCI was defined as any of the following 6 criteria: 3 vessels treated, ≥3 stents implanted, ≥3 lesions treated, bifurcation with 2 stents implanted, total stent length >60 mm, or a target of chronic total occlusion. The coprimary endpoints were major bleeding events (Bleeding Academic Research Consortium 3 or 5) and cardiovascular events (a composite of cardiovascular death, myocardial infarction, definite stent thrombosis, or ischemic stroke) at 1 month. ResultsOf the 5,966 study patients, there were 1,230 patients (20.6%) with complex PCI. Regardless of complex PCI, the effects of no aspirin relative to DAPT were not significant for the coprimary bleeding (complex PCI: 5.30% vs 3.70%; HR: 1.44; 95% CI: 0.84-2.47; P = 0.18 and noncomplex PCI: 4.26% vs 4.97%; HR: 0.85; 95% CI: 0.65-1.11; P = 0.24; P for interaction = 0.08) and cardiovascular (complex PCI: 5.78% vs 5.93%; HR: 0.98; 95% CI: 0.62-1.55; P = 0.92 and noncomplex PCI: 3.70% vs 3.10%; HR: 1.20; 95% CI: 0.88-1.63; P = 0.25; P for interaction = 0.48) endpoints without significant interactions. ConclusionsThe effects of the aspirin-free strategy relative to standard DAPT for the cardiovascular and major bleeding events were not different regardless of complex PCI. (ShorT and OPtimal duration of Dual AntiPlatelet Therapy after everolimus-eluting cobalt-chromium stent-3 [STOPDAPT-3]; NCT04609111)

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