European Heart Journal - Cardiovascular Pharmacotherapy

Aspirin versus Clopidogrel monotherapy beyond 1 month after complex percutaneous coronary intervention: A pre-specified subgroup analysis of the STOPDAPT-3 trial

Takenori Domei 1, 2, 3
, 
Ko Yamamoto 1, 2, 3
, 
Masahiro Natsuaki 4, 5
, 
Hirotoshi Watanabe 6, 7
, 
Takeshi Kimura 8, 9
, 
Yuki Obayashi 10, 11
, 
Ryusuke Nishikawa 10, 11
, 
Tomoya Kimura 8, 9, 12, 13
, 
Kenji Ando 1, 2, 3
, 
Satoru Suwa 14, 15
, 
Tsuyoshi Isawa 16, 17
, 
Hiroyuki Takenaka 6, 7
, 
Tetsuya Ishikawa 18, 19
, 
Toshihiro Tamura 20, 21
, 
Kando Kawahatsu 22, 23
, 
Fujio Hayashi 24, 25
, 
Mitsuru Abe 26, 27
, 
TAKESHI SERIKAWA 28, 29
, 
Hiroyoshi Mori 30, 31
, 
Takayuki Kawamura 32, 33
, 
Arata Hagikura 34, 35
, 
Naoki Shibata 36, 37
, 
Koh Ono 10, 11
, 
Takeshi Kimura 6, 7
Show full list: 24 authors
1
 
2
 
D , Kitakyushu 802-8555 ,
3
 
epartment of Cardiology, Kokura Memorial Hospital , Kitakyushu 802-8555 ,
4
 
5
 
6
 
Department of Cardiology, Hirakata Kohsai Hospital , Hirakata , | 
7
 
Department of Cardiology, Hirakata Kohsai Hospital , Hirakata 573-0153 , | 
8
 
9
 
Department of Clinical Epidemiology, Hyogo College of Medicine , Nishinomiya 663-8501 ,
10
 
11
 
12
 
Department of Cardiology, Japanese Red Cross Wakayama Medical Center , Wakayama , | 
13
 
Department of Cardiology, Japanese Red Cross Wakayama Medical Center , Wakayama 640-8588 ,
14
 
15
 
16
 
Department of Cardiology, Sendai Kousei Hospital , Sendai , | 
17
 
Department of Cardiology, Sendai Kousei Hospital , Sendai 981-0914 ,
18
 
19
 
20
 
21
 
Department of Cardiology, Tenri Hospital , Tenri 632-8552 ,
22
 
Department of Cardiology, Teine Keijinkai Hospital , Teine ,
23
 
Department of Cardiology, Teine Keijinkai Hospital , Teine 006-0811 ,
24
 
Department of Cardiovascular Center, Japanese Red Cross Osaka Hospital , Osaka | 
25
 
Department of Cardiovascular Center, Japanese Red Cross Osaka Hospital , Osaka 543-8555,  
26
 
27
 
Department of Cardiology, Kyoto Medical Center , Kyoto 612-0861 ,
28
 
Department of Cardiology, Fukuoka Wajiro Hospital , Fukuoka , | 
29
 
Department of Cardiology, Fukuoka Wajiro Hospital , Fukuoka 811-0213 ,
30
 
31
 
Showa University Fujigaoka Hospital , Yokohama 227-8501 ,
32
 
33
 
Department of Cardiology, Kindai University Faculty of Medicine , Osakasayama 589-8511 ,
34
 
Division of Cardiology, Tsukazaki Hospital , Himeji , | 
35
 
Division of Cardiology, Tsukazaki Hospital , Himeji 671-1227 ,
36
 
37
 
Ogaki Municipal Hospital , Ogaki 503-8502 ,
Publication type: Journal Article
Publication date: 2025-01-25
scimago Q1
SJR: 1.507
CiteScore: 10.1
Impact factor: 5.3
ISSN: 20556837, 20556845
Abstract
Aims

There were no previous studies comparing aspirin vs. P2Y12 inhibitor monotherapy following short dual antiplatelet therapy (DAPT) after complex percutaneous coronary intervention (PCI).

Methods and results

We conducted a pre-specified subgroup analysis based on complex PCI in the 1-year results of the STOPDAPT-3 (ShorT and OPtimal Duration of Dual AntiPlatelet Therapy-3) trial, which randomly compared 1-month DAPT followed by aspirin monotherapy (aspirin group) with 1-month prasugrel monotherapy followed by clopidogrel monotherapy (clopidogrel group). The main analysis in the present study was the 30-day landmark analysis. The co-primary endpoints were cardiovascular events (a composite of cardiovascular death, myocardial infarction, definite stent thrombosis, or stroke) and major bleeding (Bleeding Academic Research Consortium 3 or 5). In the 30-day landmark analysis (N = 5833), there were 1415 patients (24.3%) who underwent complex PCI. There was a significant interaction between complex PCI and the effect of the aspirin group relative to the clopidogrel group for cardiovascular events (complex PCI: 3.3% vs. 5.2%, non-complex PCI: 4.3% vs. 3.6%, interaction P = 0.04) and net adverse clinical events (complex PCI: 4.8% vs. 7.2%, non-complex PCI: 5.3% vs. 4.4%, interaction P = 0.02), but not for bleeding events (complex PCI: 2.1% vs. 2.7%, non-complex PCI: 1.7% vs. 1.4%, interaction P = 0.35).

Conclusions

There was a significant interaction between complex PCI and the effect of aspirin monotherapy relative to clopidogrel monotherapy beyond 1 month and up to 1 year for cardiovascular events due to numerically lower risk of aspirin monotherapy in patients with complex PCI, while the effect of aspirin monotherapy relative to clopidogrel monotherapy was not different for bleeding regardless of complex PCI.

Clinical trial registration

ShorT and OPtimal duration of Dual AntiPlatelet Therapy after everolimus-eluting cobalt-chromium stent-3 [STOPDAPT-3]; NCT04609111.

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