Aspirin-Free Strategy for PCI in Patients With High Bleeding Risk With or Without Acute Coronary Syndrome: A Subgroup Analysis From the STOPDAPT-3 Trial
Authors' conclusion
The aspirin-free strategy compared with the DAPT strategy failed to reduce major bleeding in patients with HBR irrespective of ACS. There was a signal of the excess risk of the aspirin-free strategy relative to the DAPT strategy for cardiovascular events, myocardial infarction in particular, in patients with ACS, but not in patients with non-ACS. The aspirin-free strategy may be considered as a potential treatment option after percutaneous coronary intervention in patients with non-ACS.
Study context
- Population
- Patients with high bleeding risk (HBR), with or without acute coronary syndrome (ACS), undergoing percutaneous coronary interventionpatients with HBR · ACS 1,803 · non-ACS 1,455
- Participants
- 3,258 patients
- Comparison
- No-aspirin with dual antiplatelet therapy
Methodological detailsstratified by ACS among patients with HBR in the STOPDAPT-3 trial
- Stratified by ACS among patients with HBR in the STOPDAPT-3 trial
Primary result
As reported in the abstract
Major bleeding · 1 month after percutaneous coronary intervention
no-aspirin vs DAPTHazard ratio (95% CI)
ACS: 7.3% versus 7.9%
0.91(0.65–1.28)
non-ACS: 3.1% versus 2.9%
1.06(0.58–1.93)
Further findings
| Outcome | No-aspirin | DAPT | HR (95% CI) | |
|---|---|---|---|---|
| Composite of cardiovascular death, myocardial infarction, definite stent thrombosis, or ischemic strokeACS | 7.9% | 5.8% | 1.39 (0.97–1.99) | |
| Composite of cardiovascular death, myocardial infarction, definite stent thrombosis, or ischemic strokenon-ACS | 2.4% | 3.0% | 0.78 (0.41–1.47) | |
| Myocardial infarctionACS · significant treatment-by-subgroup interaction | 1.6% | 0.3% | 4.57 (1.31–15.89) | |
| Myocardial infarctionnon-ACS · significant treatment-by-subgroup interaction | 1.4% | 1.8% | 0.78 (0.34–1.77) | |
| 0.050.21520Hazard ratio (log scale) |
- Composite of cardiovascular death, myocardial infarction, definite stent thrombosis, or ischemic stroke: P interaction=0.12
- Myocardial infarction: P interaction=0.02
Original publication
Aspirin-Free Strategy for PCI in Patients With High Bleeding Risk With or Without Acute Coronary Syndrome: A Subgroup Analysis From the STOPDAPT-3 Trial. Circ Cardiovasc Interv. Published 14 May 2025. doi:10.
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