An Aspirin-Free Strategy for Patients Undergoing Staged Percutaneous Coronary Intervention　― A Subgroup Analysis of the STOPDAPT-3 Trial

• Published in: Circulation Reports Vol. 7; no. 6; pp. 451 - 462
• Main Authors: Ono, Koh, Kimura, Tomoya, Watanabe, Hirotoshi, Doijiri, Tatsuki, Kimura, Takeshi, Kitahara, Hideki, Nishikawa, Ryusuke, Takenaka, Hiroyuki, Obayashi, Yuki, Yamaguchi, Koji, Ando, Kenji, Nishida, Yasunori, Morimoto, Takeshi, Yokomatsu, Takafumi, Ishino, Mitsunori, Chinen, Toshiya, Natsuaki, Masahiro, Kozuma, Ken, Suwa, Satoru, Ishikawa, Tetsuya, Yamamoto, Ko, Isawa, Tsuyoshi, on behalf of the STOPDAPT-3 Investigators
• Format: Journal Article
• Language: English
• Published: Japan The Japanese Circulation Society 10.06.2025
• Subjects: Antiplatelet therapy; Coronary stent; Ischemic Heart Disease; Original; Percutaneous coronary intervention; Antiplatelet therapy; Coronary stent; Percutaneous coronary intervention
• ISSN: 2434-0790; 2434-0790
• DOI: 10.1253/circrep.CR-25-0026

Background: No previous studies have evaluated the effect of an aspirin-free strategy for patients undergoing staged percutaneous coronary intervention (PCI).Methods and Results: We conducted a post hoc subgroup analysis in patients undergoing staged PCI within 1 month in STOPDAPT-3 (n=6,002), which randomly compared prasugrel monotherapy with dual antiplatelet therapy (DAPT) in patients with acute coronary syndrome or high bleeding risk. The co-primary endpoints were major bleeding (Bleeding Academic Research Consortium 3 or 5) and cardiovascular events (a composite of cardiovascular death, myocardial infarction, definite stent thrombosis, or stroke) at 1 month. There were 814 patients undergoing staged PCI within 1 month (no-aspirin group, n=401; DAPT group, n=413). The median interval from randomization to the first staged PCI was 8 (interquartile range 5–13) days. More than 90% of the patients received assigned antiplatelet agents at all staged PCI procedures. The effect of no-aspirin relative to DAPT was not different for the co-primary bleeding (3.74% vs. 1.94%; HR 1.94; 95% CI 0.82–4.57) and cardiovascular (3.49% vs. 2.42%; HR 1.44; 95% CI 0.64–3.25) endpoints. The no-aspirin group compared with the DAPT group had a numerically higher incidence of the co-primary cardiovascular endpoint, which occurred after the first staged PCI procedure (2.49% vs. 1.21%; HR 2.07; 95% CI 0.71–6.05).Conclusions: An aspirin-free prasugrel monotherapy relative to DAPT had numerically higher risks of cardiovascular and major bleeding events in patients undergoing staged PCI at 1 month.