Aspirin-Free Strategy for PCI in Patients With High Bleeding Risk With or Without Acute Coronary Syndrome: A Subgroup...

Area of Science:

• Cardiology
• Interventional Cardiology

Background:

• The efficacy of aspirin-free strategies for bleeding and cardiovascular events in high bleeding risk (HBR) patients undergoing percutaneous coronary intervention (PCI) was previously unknown.
• Patients with or without acute coronary syndrome (ACS) were included in this analysis.

Purpose of the Study:

• To evaluate the effects of an aspirin-free strategy versus dual antiplatelet therapy (DAPT) on bleeding and cardiovascular outcomes in HBR patients undergoing PCI.
• To assess outcomes stratified by the presence or absence of ACS.

Main Methods:

• A subgroup analysis of the STOPDAPT-3 trial was performed, comparing no-aspirin (prasugrel monotherapy) with DAPT in HBR patients.
• The analysis included 3258 patients, with 1803 having ACS and 1455 without ACS.

Main Results:

• No significant difference in major bleeding was observed between the aspirin-free and DAPT groups, regardless of ACS status (7.3% vs. 7.9% and 3.1% vs. 2.9%).
• A numerically higher risk for a composite of cardiovascular death, myocardial infarction, stent thrombosis, or ischemic stroke was noted in the aspirin-free group for ACS patients (7.9% vs. 5.8%), but not for non-ACS patients (2.4% vs. 3.0%).
• A significant interaction was found for myocardial infarction, with a higher risk in the aspirin-free group for ACS patients (1.6% vs. 0.3%; P interaction=0.02).

Conclusions:

• The aspirin-free strategy did not reduce major bleeding in HBR patients undergoing PCI, irrespective of ACS.
• A potential increased risk of cardiovascular events, particularly myocardial infarction, was observed with the aspirin-free strategy in ACS patients.
• The aspirin-free strategy may be a viable treatment option for non-ACS patients post-PCI.