Prasugrel monotherapy after percutaneous coronary intervention (PCI) with drug-eluting stents is not superior to dual-antiplatelet therapy (DAPT) for major bleeding but is non-inferior for cardiovascular events in patients with acute coronary syndrome (ACS) or high bleeding risk (HBR), according to late breaking research presented in a Hot Line session today at ESC Congress 2023.
Very short durations of DAPT followed by P2Y12 inhibitor monotherapy has been shown to reduce bleeding events without increasing cardiovascular events compared with standard durations of DAPT after PCI using drug-eluting stents. However, the incidence of major bleeding events within the 1-month mandatory DAPT period after PCI remains high in real clinical practice, particularly in patients with ACS or HBR.
STOPDAPT-3 investigated the efficacy and safety of aspirin-free prasugrel monotherapy compared with 1-month DAPT with aspirin and prasugrel in patients with ACS or HBR undergoing PCI with cobalt-chromium everolimus-eluting stents. From January 2021 to April 2023, the study enrolled 6,002 patients with ACS or HBR from 72 centers in Japan.
The full analysis set population consisted of 5,966 patients . The average age was 71.6 years and 23.4% were women. At 1 month, the no-aspirin strategy was not superior to DAPT for the co-primary bleeding endpoint . The no-aspirin strategy was non-inferior to DAPT with a relative 50% margin for the co-primary cardiovascular endpoint .