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. 2025 Apr 29;7(6):451-462.
doi: 10.1253/circrep.CR-25-0026. eCollection 2025 Jun 10.

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

Ko Yamamoto  1 , Masahiro Natsuaki  2 , Hirotoshi Watanabe  3 , Takeshi Morimoto  4 , Yuki Obayashi  5 , Ryusuke Nishikawa  5 , Tomoya Kimura  4   6 , Kenji Ando  1 , Satoru Suwa  7 , Tsuyoshi Isawa  8 , Hiroyuki Takenaka  3 , Tetsuya Ishikawa  9 , Takafumi Yokomatsu  10 , Toshiya Chinen  11 , Tatsuki Doijiri  12 , Ken Kozuma  13 , Yasunori Nishida  14 , Koji Yamaguchi  15 , Hideki Kitahara  16 , Mitsunori Ishino  17 , Koh Ono  5 , Takeshi Kimura  3 ; STOPDAPT-3 Investigators
Affiliations

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

Ko Yamamoto et al. Circ Rep. .

Abstract

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.

Keywords: Antiplatelet therapy; Coronary stent; Percutaneous coronary intervention.

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Figures

Figure 1.
Figure 1.
Study flow chart. ACS, acute coronary syndrome; DAPT, dual antiplatelet therapy; HBR, high bleeding risk; PCI, percutaneous coronary intervention.
Figure 2.
Figure 2.
Kaplan-Meier curves for the co-primary endpoints. (A) Co-primary bleeding endpoint, and (B) co-primary cardiovascular endpoint. CI, confidence interval; DAPT, dual antiplatelet therapy; HR, hazard ratio.
See this image and copyright information in PMC

References

    1. Spitzer E, McFadden E, Vranckx P, de Vries T, Ren B, Collet C, et al.. Defining staged procedures for percutaneous coronary intervention trials: A guidance document. JACC Cardiovasc Interv 2018; 11: 823–832. - PubMed
    1. Toyota T, Morimoto T, Shiomi H, Yamaji K, Ando K, Ono K, et al.. Single-session versus staged procedures for elective multivessel percutaneous coronary intervention. Heart 2018; 104: 936–944. - PubMed
    1. Yamamoto K, Shiomi H, Morimoto T, Miyazawa A, Watanabe H, Nakamura S, et al.. Single-session versus staged multivessel optimal IVUS-guided PCI in patients with CCS or NSTE-ACS. JACC Asia 2023; 3: 649–661. - PMC - PubMed
    1. Kawashima H, Tomaniak M, Ono M, Wang R, Hara H, Gao C, et al.. Safety and efficacy of 1-month dual antiplatelet therapy (ticagrelor+aspirin) followed by 23-month ticagrelor monotherapy in patients undergoing staged percutaneous coronary intervention (a sub-study from GLOBAL LEADERS). Am J Cardiol 2021; 138: 1–10. - PubMed
    1. Byrne RA, Rossello X, Coughlan JJ, Barbato E, Berry C, Chieffo A, et al.. 2023 ESC guidelines for the management of acute coronary syndromes. Eur Heart J 2023; 44: 3720–3826. - PubMed