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

• Published in: JACC. Cardiovascular interventions Vol. 17; no. 9; pp. 1119 - 1130
• Main Authors: Yamamoto, Ko, Natsuaki, Masahiro, Watanabe, Hirotoshi, Morimoto, Takeshi, Obayashi, Yuki, Nishikawa, Ryusuke, Ando, Kenji, Suwa, Satoru, Isawa, Tsuyoshi, Takenaka, Hiroyuki, Ishikawa, Tetsuya, Tamura, Toshihiro, Kawahatsu, Kando, Hayashi, Fujio, Akao, Masaharu, Serikawa, Takeshi, Mori, Hiroyoshi, Kawamura, Takayuki, Hagikura, Arata, Shibata, Naoki, Ono, Koh, Kimura, Takeshi, Wakabayashi, Kohei, Onishi, Yuko, Hibi, Kiyoshi, Kawai, Kazuya, Yoshida, Ruka, Suzuki, Hiroshi, Nakazawa, Gaku, Kusuyama, Takanori, Morishima, Itsuro, Tokuyama, Hideo, Sakamoto, Hiroki, Fujita, Takanari, Nanasato, Mamoru, Okayama, Hideki, Kadota, Kazushige, Hata, Yoshiki, Akashi, Yoshihiro J., Matsuoka, Shunzo, Tanaka, Hiroyuki, Yamada, Minoru, Wakatsuki, Tetsuzo, Nozaki, Yoichi, Kobayashi, Yoshio, Kato, Ryuichi, Ikari, Yuji, Kurita, Tairo, Kaitani, Kazuaki, Sugimoto, Atsuhiko, Ogata, Nobuhiko, Yokomatsu, Takafumi, Uehara, Hiroki, Doijiri, Tatsuki, Kozuma, Ken, Nishida, Yasunori, Yamaguchi, Junichi, Morino, Yoshihiro, Tanigawa, Takashi, Nakano, Yukiko, Makiguchi, Noriko, Noda, Toshiyuki, Shiode, Nobuo, Abe, Koji, Abe, Shichiro, Tabuchi, Isao, Ishihara, Shozo, Kinoshita, Makoto, Higuchi, Motoaki, Takaya, Tomofumi, Miura, Shin-Ichiro, Tsubakimoto, Yoshinori, Tsujita, Kenichi, Kumagai, Koji, Tanabe, Kengo, Inoko, Moriaki, Nakagami, Takuo, Tomita, Hirofumi, Nakano, Masatsugu, Yumoto, Kazuhiko, Wakeyama, Takatoshi, Kaneko, Takeo, Doi, Masayuki
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 13.05.2024
• Subjects: Acute Coronary Syndrome - diagnostic imaging; Acute Coronary Syndrome - therapy; Aged; antiplatelet therapy; Aspirin - administration & dosage; Aspirin - adverse effects; Aspirin - therapeutic use; Chromium Alloys; complexity; Coronary Artery Disease - diagnostic imaging; Coronary Artery Disease - mortality; Coronary Artery Disease - therapy; coronary stent; Coronary Thrombosis - etiology; Coronary Thrombosis - prevention & control; Drug Administration Schedule; Drug Therapy, Combination; Drug-Eluting Stents; Dual Anti-Platelet Therapy; Everolimus - administration & dosage; Everolimus - adverse effects; Female; Hemorrhage - chemically induced; Hemorrhage - prevention & control; Humans; Male; Middle Aged; percutaneous coronary intervention; Percutaneous Coronary Intervention - adverse effects; Percutaneous Coronary Intervention - instrumentation; Percutaneous Coronary Intervention - mortality; Platelet Aggregation Inhibitors - administration & dosage; Platelet Aggregation Inhibitors - adverse effects; Prasugrel Hydrochloride - administration & dosage; Prasugrel Hydrochloride - adverse effects; Prasugrel Hydrochloride - therapeutic use; Prosthesis Design; Risk Assessment; Risk Factors; Time Factors; Treatment Outcome; complexity; ACS; percutaneous coronary intervention; RCT; PCI; coronary stent; antiplatelet therapy; DAPT
• ISSN: 1936-8798; 1876-7605; 1876-7605
• DOI: 10.1016/j.jcin.2024.03.017

There was no study evaluating the effects of an aspirin-free strategy in patients undergoing complex percutaneous coronary intervention (PCI). The authors aimed to evaluate the efficacy and safety of an aspirin-free strategy in patients undergoing complex PCI. 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. 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. 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) [Display omitted]