Coronary disease & ACS

Aspirin Omission at the Time of Primary Percutaneous Coronary Intervention in STEMI

N Engl J MedPublished Randomised controlled trial

Primary resultResult — go to the resultHazard ratio 1.34 95% CI 1.02–1.75

Authors' conclusion

Among patients with STEMI who were undergoing primary PCI, low-dose prasugrel monotherapy initiated before PCI was not noninferior to DAPT for 12 months with respect to a composite of death from any cause, stroke, or myocardial infarction at 12 months.

Study context

Population
Patients with STEMI undergoing primary percutaneous coronary intervention (PCI), Japanfull analysis population
Participants
2,216 patients
Comparison
Low-dose prasugrel monotherapy vs dual antiplatelet therapy (DAPT)
  • Monotherapyn = 1,109
  • DAPTn = 1,107reference
Primary endpoint
Death from any cause, stroke or MI
Follow-up
12 months
Methodological detailsmulticentre, open-label, non-inferiority
  • Multicentre
  • Open-label
  • Non-inferiority

Primary result

As reported in the abstract

Hazard ratio

1.34

95% CI 1.02–1.75

P = 0.40 for noninferiority

Events by treatment group

Monotherapyvs DAPT
HR 1.34 (95% CI 1.02–1.75); P = 0.40 for noninferiority

Secondary outcomes

Definite or probable stent thrombosis

Appeared similar in the two groups

Safety

OutcomeMonotherapyDAPTHR (95% CI)
Major bleeding (BARC type 3 or 5) · 12 monthsMajor secondary outcome · Kaplan-Meier estimates5.6%8.4%0.66 (0.47–0.91)

Serious adverse events

Appeared similar in the two groups

Original publication

Aspirin Omission at the Time of Primary Percutaneous Coronary Intervention in STEMI. N Engl J Med. Published 29 August 2026. doi:10.1056/nejmoa2606997

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