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An Aspirin-Free Strategy for Immediate Treatment Following Complex Percutaneous Coronary Intervention
Ko Yamamoto1, Masahiro Natsuaki2, Hirotoshi Watanabe3
1Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan.
Insights
An aspirin-free strategy showed no significant difference in bleeding or cardiovascular events compared to standard dual antiplatelet therapy (DAPT) in patients undergoing complex percutaneous coronary intervention (PCI). This finding supports aspirin-free DAPT as a safe alternative for complex PCI patients.
Area of Science:
- Cardiology
- Interventional Cardiology
- Pharmacology
Background:
- Limited research exists on aspirin-free strategies for complex percutaneous coronary intervention (PCI).
- Evaluating the efficacy and safety of an aspirin-free approach in this patient group is crucial.
Purpose of the Study:
- To assess the effectiveness and safety of an aspirin-free strategy versus standard dual antiplatelet therapy (DAPT) in patients undergoing complex PCI.
- To determine if aspirin cessation impacts major bleeding or cardiovascular events in this specific population.
Main Methods:
- A subgroup analysis from the STOPDAPT-3 trial was conducted, focusing on patients with complex PCI.
- Complex PCI was defined by criteria including multiple vessels, stents, lesions, long stent length, or chronic total occlusion.
- Patients received either low-dose prasugrel monotherapy (aspirin-free) or DAPT with low-dose prasugrel and aspirin.
Main Results:
- In complex PCI patients, the aspirin-free strategy showed no significant difference in major bleeding (5.30% vs 3.70%) compared to DAPT.
- Cardiovascular events were also not significantly different between the aspirin-free and DAPT groups in complex PCI patients (5.78% vs 5.93%).
- No significant interactions were observed for bleeding or cardiovascular outcomes between complex and non-complex PCI groups.
Conclusions:
- The aspirin-free strategy is comparable to standard DAPT regarding cardiovascular events and major bleeding in patients undergoing complex PCI.
- These findings suggest that an aspirin-free approach can be considered for patients with complex PCI.
- The study did not find a significant difference in outcomes regardless of PCI complexity.
Background:
There was no study evaluating the effects of an aspirin-free strategy in patients undergoing complex percutaneous coronary intervention (PCI).
Objectives:
The authors aimed to evaluate the efficacy and safety of an aspirin-free strategy in patients undergoing complex PCI.
Methods:
We 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.
Results:
Of 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.
Conclusions:
The 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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