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Coronary disease & ACSSecondary analysis

Aspirin vs Clopidogrel 1 Month After Acute Coronary Syndrome With High-Bleeding Risk or ST-Segment Elevation

JACC Cardiovasc IntervPublished

  • Secondary analysis of the STOPDAPT-3 randomised trial
  • prespecified subgroups
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Authors' conclusion

In patients with ACS, aspirin and clopidogrel demonstrated comparable effects on both cardiovascular and bleeding outcomes beyond 1 month and up to 1 year after percutaneous coronary intervention, irrespective of HBR or non-HBR and STEMI or NSTE-ACS.

Study context

Population
Patients with acute coronary syndrome (ACS) after PCI, by high bleeding risk (HBR) or non-HBR and STEMI or NSTE-ACS1,711 HBR
Participants
4,353 patients
Comparison
Aspirin vs clopidogrel monotherapy beyond 30 days up to 1 year after PCI
Primary endpoint
Coprimary: CV endpoint (CV death, MI, definite stent thrombosis or ischemic stroke); bleeding endpoint (major bleeding, BARC type 3 or 5)
Follow-up
Beyond 30 days and up to 1 year

Primary result

As reported in the abstract

CV endpoint, by subgroup · 335-day follow-up
Aspirin vs ClopidogrelHazard ratio (95% CI)
HBR
0.89(0.61–1.30)
non-HBR
1.08(0.61–1.90)
STEMI
1.01(0.68–1.50)
NSTE-ACS
0.81(0.48–1.37)

Safety

Major bleeding (BARC type 3 or 5), coprimary bleeding endpoint, by HBR and ACS subtype (prespecified subgroups) · beyond 30 days up to 1 year (335-day follow-up)

Aspirin vs clopidogrel, HBR: HR
0.73 (0.40-1.33) (95% CI)
Aspirin vs clopidogrel, non-HBR: HR
0.71 (0.23-2.24) (95% CI)
Aspirin vs clopidogrel, STEMI: HR
0.96 (0.46-2.01) (95% CI)
Aspirin vs clopidogrel, NSTE-ACS: HR
0.53 (0.24-1.17) (95% CI)
HRs for bleeding endpoints not significant in all subgroups
  • HBR vs non-HBR interaction P = 0.97
  • STEMI vs NSTE-ACS interaction P = 0.28
  • crude HRs

Original publication

Aspirin vs Clopidogrel 1 Month After Acute Coronary Syndrome With High-Bleeding Risk or ST-Segment Elevation. JACC Cardiovasc Interv. Published 4 June 2025. doi:10.1016/j.jcin.2025.03.029
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Summarised from the published abstract; every number is checked against it