Article
作者: Ikari, Yuji ; Shiode, Nobuo ; Kozuma, Ken ; Abe, Koji ; Yamamoto, Ko ; Kaitani, Kazuaki ; Ogata, Nobuhiko ; Akashi, Yoshihiro J ; Hayashi, Fujio ; Kurita, Tairo ; Nishida, Yasunori ; Hibi, Kiyoshi ; Matsuoka, Shunzo ; Natsuaki, Masahiro ; Kimura, Takeshi ; Inoko, Moriaki ; Kawahatsu, Kando ; Kumagai, Koji ; Ishihara, Shozo ; Morino, Yoshihiro ; Nakano, Yukiko ; Nishikawa, Ryusuke ; Morishima, Itsuro ; Tanaka, Hiroyuki ; Fujita, Takanari ; Hata, Yoshiki ; Suzuki, Hiroshi ; Wakabayashi, Kohei ; Okayama, Hideki ; Morimoto, Takeshi ; Watanabe, Hirotoshi ; Yamada, Minoru ; Tanabe, Kengo ; Yamaguchi, Junichi ; Nozaki, Yoichi ; Wakatsuki, Tetsuzo ; Sakamoto, Hiroki ; Noda, Toshiyuki ; Onishi, Yuko ; Takenaka, Hiroyuki ; Nakazawa, Gaku ; Ando, Kenji ; Nakano, Masatsugu ; Nanasato, Mamoru ; Kawai, Kazuya ; Kaneko, Takeo ; Yokomatsu, Takafumi ; Sugimoto, Atsuhiko ; Makiguchi, Noriko ; Takaya, Tomofumi ; Kato, Ryuichi ; Kobayashi, Yoshio ; Kinoshita, Makoto ; Obayashi, Yuki ; Isawa, Tsuyoshi ; Nishikura, Tenjin ; Higuchi, Motoaki ; Miura, Shin-Ichiro ; Yoshida, Ruka ; Nishida, Koji ; Doi, Masayuki ; Tamura, Toshihiro ; Kirigaya, Hidekuni ; Abe, Shichiro ; Tsujita, Kenichi ; Ishikawa, Tetsuya ; Wakeyama, Takatoshi ; Doijiri, Tatsuki ; Nakagami, Takuo ; Tabuchi, Isao ; Tanigawa, Takashi ; Ono, Koh ; Akao, Masaharu ; Tomita, Hirofumi ; Serikawa, Takeshi ; Tsubakimoto, Yoshinori ; Uehara, Hiroki ; Kadota, Kazushige ; Suwa, Satoru ; Yumoto, Kazuhiko ; Kusuyama, Takanori ; Tokuyama, Hideo
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.