Early Aspirin Discontinuation Following PCI for Acute Coronary Syndromes: A Systematic Review and Meta-Analysis of Reconstructed Individual Patient Data.

BACKGROUND: Dual antiplatelet therapy (DAPT) is well established for patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI). Contemporary studies demonstrated that a shorter DAPT strategy may reduce bleeding, while preserving ischemic protection. However, optimal timing of aspirin discontinuation remains uncertain. METHODS: We performed a systematic review and meta-analysis of randomized controlled trials comparing standard 12-month DAPT versus early aspirin discontinuation (≤1-2 months), following PCI for ACS, excluding studies with immediate aspirin withdrawal. We systematically searched PubMed, Embase, and Cochrane. Individual patient data were reconstructed from Kaplan-Meier (KM) curves. Hazard ratios (HRs) and their 95% CIs were estimated using Cox regression. All statistical analyses were performed using R software, version 4.5.0. RESULTS: We included 5 randomized controlled trials comprising 12,984 patients; 6473 (49.8%) were randomized to early aspirin discontinuation. Short-term DAPT was associated with a reduction in the risk of bleeding (HR, 0.44; 95% CI, 0.34-0.55; P < .001), while preserving ischemic protection, with no differences in the risk of major adverse cardiac events (HR, 1.05; 95% CI, 0.83-1.32; P = .71). Stratified bleeding analyses demonstrated a reduction in major bleeding (HR, 0.40; 95% CI, 0.26-0.61; P < .01) and a reduction in clinically relevant bleeding (HR, 0.43; 95% CI, 0.34-0.55; P < .001). CONCLUSION: In trials evaluating aspirin discontinuation at approximately 1 month following PCI for ACS, transitioning to P2Y12 inhibitor monotherapy reduced bleeding while preserving ischemic protection in selected patients.