An Aspirin-Free Strategy for Immediate Treatment Following Complex Percutaneous Coronary Intervention.
JACC Cardiovasc Interv
; 17(9): 1119-1130, 2024 May 13.
Article
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| MEDLINE
| ID: mdl-38749592
ABSTRACT
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).Palabras clave
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Diseño de Prótesis
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Enfermedad de la Arteria Coronaria
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Esquema de Medicación
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Inhibidores de Agregación Plaquetaria
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Aspirina
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Stents Liberadores de Fármacos
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Intervención Coronaria Percutánea
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Everolimus
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Clorhidrato de Prasugrel
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Terapia Antiplaquetaria Doble
Idioma:
En
Revista:
JACC Cardiovasc Interv
Asunto de la revista:
ANGIOLOGIA
/
CARDIOLOGIA
Año:
2024
Tipo del documento:
Article
País de afiliación:
Japón
Pais de publicación:
Estados Unidos