Is aspirin needed after a certain type of heart attack?
Monotherapy using prasugrel failed to show noninferiority compared with potent antiplatelet therapy plus aspirin at the time of primary percutaneous coronary intervention for ST-segment elevation myocardial infarction. This was the main finding of the PREMIUM trial presented in a Hot Line session at ESC Congress 2026 and published simultaneously in the New England Journal of Medicine.
A major clinical trial has found that immediate use of prasugrel monotherapy after a specific type of heart attack (STEMI) treated with primary percutaneous coronary intervention (PCI) does not provide noninferiority to the standard combination of prasugrel and aspirin for 12 months. The PREMIUM trial, conducted at 69 centers in Japan, included 2,280 patients with STEMI requiring PCI using modern platinum-chromium everolimus-eluting stents.
While major bleeding was lower with prasugrel monotherapy, the study did not demonstrate its safety compared to the standard dual antiplatelet therapy (DAPT) consisting of prasugrel and aspirin. The findings support the continued use of DAPT for at least the first month following primary PCI in STEMI patients, although the optimal duration of dual antiplatelet therapy remains to be determined.
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