High Bleeding Risk and Aspirin Omission at the Time of Primary PCI in STEMI: A Post Hoc Analysis of the PREMIUM Trial.

ARC-HBR criteria identify STEMI patients undergoing primary PCI with substantially higher 12-month risk, but do not show a more favorable effect for upfront aspirin omission.

• Why it matters: High bleeding risk complicates antiplatelet selection because these patients also face higher ischemic event rates, yet it is unclear whether HBR can flag those who might safely omit aspirin.
• What they did: In the PREMIUM trial post hoc analysis of 2,189 STEMI patients randomized to low-dose prasugrel monotherapy versus DAPT, aspirin could be stopped at 3 months only in ARC-HBR patients. Outcomes were assessed by HBR status for 12-month composite ischemic events and major bleeding.
• The result: HBR patients had higher primary outcome rates (16.2% vs 6.2%; HR 2.68) and major bleeding (10.9% vs 4.9%; HR 2.28), but aspirin omission showed no significant HBR-specific benefit (interaction P=0.51 for primary; P=0.67 for bleeding).

AI summary of the abstract · may contain errors · not medical advice · read the paper.