An Aspirin-Free Strategy for Immediate Treatment Following Complex Percutaneous Coronary Intervention
Authors' conclusion
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.
Study context
- Population
- Patients with ACS or high bleeding risk undergoing percutaneous coronary intervention (PCI); complex PCI (3 vessels treated, ≥3 stents, ≥3 lesions, bifurcation with 2 stents, total stent length >60 mm, or CTO target)1,230 (20.6%) complex PCI
- Participants
- 5,966 patients
- Comparison
- Aspirin-free low-dose prasugrel monotherapy vs dual antiplatelet therapy (DAPT), by complex vs noncomplex PCI
- Primary endpoint
- Coprimary: major bleeding (BARC 3 or 5) and CV events (CV death, MI, definite stent thrombosis or ischemic stroke)
- Follow-up
- 1 month
Methodological detailsprespecified subgroup analysis
- Prespecified subgroup analysis
Primary result
As reported in the abstract
Coprimary endpoints by complex PCI (subgroups)
No aspirin vs DAPTHazard ratio (95% CI)P value
Major bleeding, complex PCI: 5.30% vs 3.70%
1.44(0.84–2.47)
P = 0.18Major bleeding, noncomplex PCI: 4.26% vs 4.97%
0.85(0.65–1.11)
P = 0.24CV events, complex PCI: 5.78% vs 5.93%
0.98(0.62–1.55)
P = 0.92CV events, noncomplex PCI: 3.70% vs 3.10%
1.20(0.88–1.63)
P = 0.25- Major bleeding: interaction
- P for interaction = 0.08
- CV events: interaction
- P for interaction = 0.48
Original publication
An Aspirin-Free Strategy for Immediate Treatment Following Complex Percutaneous Coronary Intervention. JACC Cardiovasc Interv. Published 13 May 2024. doi:10.
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