High-Intensity Statins and the Post-Discharge Clinical Outcomes at 1 Year After Percutaneous Coronary Intervention ― Insights From STOPDAPT-3 ―

Background: The use of high-intensity statins is recommended to improve the prognosis of coronary artery disease. However, it remains unclear whether they offer a short-term benefit after percutaneous coronary intervention (PCI), regardless of the acute coronary syndrome (ACS) status. Methods and Results: We performed a post hoc analysis of STOPDAPT-3, which compared 1-month aspirin-free prasugrel monotherapy followed by clopidogrel monotherapy with 1-month dual antiplatelet therapy (DAPT) followed by aspirin monotherapy in patients with ACS or a high bleeding risk undergoing PCI. High-intensity statins were defined as the maximum approved dose of strong statins in Japan (e.g., rosuvastatin 10 mg, atorvastatin 20 mg, or pitavastatin 4 mg). Two co-primary endpoints were the study-defined cardiovascular composite endpoint and bleeding endpoint, assessed between hospital discharge and 1 year after randomization. Among 5,823 patients discharged alive, 2,829 (48.6%) received high-intensity statins (ACS 54.4%; non-ACS 31.5%; P<0.001). The 1-year post-discharge cumulative incidence of cardiovascular events was similar between patients who received high-intensity statins and those who did not (3.90% vs. 4.27%, P=0.51; adjusted HR 1.03; 95% CI 0.74-1.44; P=0.84). Conclusions: In STOPDAPT-3, high-intensity statin therapy at discharge was not associated with a reduced risk of cardiovascular events 1 year after PCI, under the limitations of having no laboratory test or prescription data available during the follow up.