Aspirin reloading before percutaneous coronary intervention on chronic aspirin therapy: reduced early ischemia without bleeding trade-off

Abstract Background While clopidogrel reloading has established benefits in acute acute coronary syndrome (ACS) patients, the role of aspirin reloading in patients with chronic aspirin therapy undergoing percutaneous coronary intervention (PCI) remains underexplored. Purpose To evaluate safety and efficacy of aspirin reloading in patients on chronic aspirin therapy undergoing PCI. Methods This multicenter retrospective cohort study (2010-2024) analyzed 52,929 patients who underwent PCI across 82 hospitals. Patients were divided into aspirin reload group (300 mg within 24h pre-PCI, n=8823) and maintenance group (100 mg, n=44106). Propensity score matching (PSM) was used to balance the differences between the two groups. The Kaplan-Meier analysis with log-rank tests compared the endpoint risk between the two groups. The primary endpoint focused on Major Adverse Cardiovascular and Cerebrovascular Events (MACCE), including cardiac death, myocardial infarction (MI), stroke, and target vessel revascularization (TVR). Results After 1: 1 PSM, 8,626 well-balanced patient pairs were included (all covariates with standardized differences 10%). The aspirin reload group demonstrated significantly lower risk of 1-month MACCE compared to the maintenance group (1.69% vs 3.41%, HR: 0.51, 95%CI: 0.418-0.607, P 0.001) (Figure 1). However, this advantage diminished at 3 months (6.35% vs. 6.57%) and 6 months (8.23% vs. 8.16%). A sustained reduction in MI was observed in the reload group at 1 month (0.25% vs. 0.58%), 3 months (0.61% vs. 0.90%) and 6 months (0.83% vs. 1.15%; all P 0.05). The 1-month TVR rate showed an reduction with reloading (0.50% vs. 2.46%, P 0.001). No significant differences were observed in cardiac death, stroke, cerebral hemorrhage, or BARC type 2,3 or 5 at 1, 3 and 6 month (all P 0.05) (Table 1). Conclusion This study was the first to provide real-world evidence that aspirin reloading reduces the incidence of 1-month MACCE without increasing the risk of bleeding events in patients undergoing PCI. Although the beneficial effect diminished after 3 months, the acute-phase advantages may offer critical protection for high-risk patients. These findings need validation through randomized trials to establish the optimal dosing and timing.Figure 1.1-month Kaplan-Meier Curve Table 1.Endpoints at 1,3,6 months