Aspirin-free strategy for percutaneous coronary intervention in acute coronary syndrome based on the subtypes of acute coronary syndrome and high bleeding risk: the STOPDAPT-3 trial.

Autor:	Obayashi Y; Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan., Natsuaki M; Department of Cardiovascular Medicine, Saga University, Saga 849-8501, Japan., Watanabe H; Division of Cardiology, Hirakata Kohsai Hospital, Hirakata 573-0153, Japan., Morimoto T; Department of Clinical Epidemiology, Hyogo Medical University, Nishinomiya 663-8501, Japan., Yamamoto K; Department of Cardiology, Kokura Memorial Hospital, Kitakyusyu 802-8555, Japan., Nishikawa R; Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan., Ando K; Department of Cardiology, Kokura Memorial Hospital, Kitakyusyu 802-8555, Japan., Suwa S; Department of Cardiology, Juntendo University Shizuoka Hospital, Izunokuni 410-2295, Japan., Isawa T; Department of Cardiology, Sendai Kousei Hospital, Sendai 980-0873, Japan., Takenaka H; Division of Cardiology, Hirakata Kohsai Hospital, Hirakata 573-0153, Japan., Ishikawa T; Department of Cardiology, Dokkyo Medical University Saitama Medical Center, Koshigaya 343-8555, Japan., Tokuyama H; Department of Cardiology, Kawaguchi Cardiovascular and Respiratory Hospital, Kawaguchi 333-0842, Japan., Sakamoto H; Department of Cardiology, Shizuoka General Hospital, Shizuoka 420-8527, Japan., Fujita T; Division of Cardiology, Japanese Red Cross Wakayama Medical Center, Wakayama 640-8558, Japan., Nanasato M; Department of Cardiology, Sakakibara Heart Institute, Fuchu 183-0003, Japan., Okayama H; Department of Cardiology, Ehime Prefectural Central Hospital, Matsuyama 790-0024, Japan., Nishikura T; Department of Cardiology, Showa University Koto Toyosu Hospital, Tokyo 135-8577, Japan., Kirigaya H; Division of Cardiology, Yokohama City University Medical Center, Yokohama 232-0024, Japan., Nishida K; Division of Cardiology, Chikamori Hospital, Kochi 780-8522, Japan., Ono K; Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan., Kimura T; Division of Cardiology, Hirakata Kohsai Hospital, Hirakata 573-0153, Japan.
Jazyk:	angličtina
Zdroj:	European heart journal. Cardiovascular pharmacotherapy [Eur Heart J Cardiovasc Pharmacother] 2024 Aug 14; Vol. 10 (5), pp. 374-390.
DOI:	10.1093/ehjcvp/pvae009
Abstrakt:	Background and Aims: High bleeding risk (HBR) and acute coronary syndrome (ACS) subtypes are critical in determining bleeding and cardiovascular event risk after percutaneous coronary intervention (PCI). Methods and Results: In 4476 ACS patients enrolled in the STOPDAPT-3, where the no-aspirin and dual antiplatelet therapy (DAPT) strategies after PCI were randomly compared, the pre-specified subgroup analyses were conducted based on HBR/non-HBR and ST-segment elevation myocardial infarction (STEMI)/non-ST-segment elevation ACS (NSTE-ACS). The co-primary bleeding endpoint was Bleeding Academic Research Consortium (BARC) type 3 or 5, and the co-primary cardiovascular endpoint was a composite of cardiovascular death, myocardial infarction, definite stent thrombosis, or ischaemic stroke at 1 month. Irrespective of the subgroups, the effect of no-aspirin compared with DAPT was not significant for the bleeding endpoint (HBR [N = 1803]: 7.27 and 7.91%, hazard ratio (HR) 0.91, 95% confidence interval (CI) 0.65-1.28; non-HBR [N = 2673]: 3.40 and 3.65%, HR 0.93, 95% CI 0.62-1.39; Pinteraction = 0.94; STEMI [N = 2553]: 6.58 and 6.56%, HR 1.00, 95% CI 0.74-1.35; NSTE-ACS [N = 1923]: 2.94 and 3.64%, HR 0.80, 95% CI 0.49-1.32; Pinteraction = 0.45), and for the cardiovascular endpoint (HBR: 7.87 and 5.75%, HR 1.39, 95% CI 0.97-1.99; non-HBR: 2.56 and 2.67%, HR 0.96, 95% CI 0.60-1.53; Pinteraction = 0.22; STEMI: 6.07 and 5.46%, HR 1.11, 95% CI 0.81-1.54; NSTE-ACS: 3.03 and 1.71%, HR 1.78, 95% CI 0.97-3.27; Pinteraction = 0.18). Conclusion: In patients with ACS undergoing PCI, the no-aspirin strategy compared with the DAPT strategy failed to reduce major bleeding events irrespective of HBR and ACS subtypes. The numerical excess risk of the no-aspirin strategy relative to the DAPT strategy for cardiovascular events was observed in patients with HBR and in patients with NSTE-ACS. (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.)
Databáze:	MEDLINE
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