J Am Coll Cardiol. 2023;82(16):1565-1578.
Comparison of Antiplatelet Monotherapies After Percutaneous Coronary Intervention According to Clinical, Ischemic, and Bleeding Risks.
제1저자 양석훈, 강지훈 · 교신저자 박경우, 허승호
소속 (12)
- Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
- Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea. Electronic address: kwparkmd@snu.ac.kr.
- Keimyung University Dongsan Hospital, Daegu, Republic of Korea. Electronic address: shur@dsmc.or.kr.
- Kangnam Sacred Heart Hospital, Hallym University, Seoul, Republic of Korea.
- Uijeongbu St Mary's Hospital, Uijeongbu, Republic of Korea.
- Pusan National University Hospital, Busan, Republic of Korea.
- Hallym University Sacred Heart Hospital, Anyang, Republic of Korea.
- Daegu Catholic University Medical Center, Daegu, Republic of Korea.
- Anyang SAM Medical Center, Anyang, Republic of Korea.
- Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Republic of Korea.
- Inha University Hospital, Inha University, Incheon, Republic of Korea.
- Ulsan University Hospital, Ulsan, Republic of Korea.
Abstract
BACKGROUND Clopidogrel was superior to aspirin monotherapy in secondary prevention after percutaneous coronary intervention (PCI).
OBJECTIVES The purpose of this study was to evaluate the benefits of clopidogrel across high-risk subgroups METHODS: This was a post hoc analysis of the HOST-EXAM (Harmonizing Optimal Strategy for Treatment of coronary artery diseases-EXtended Antiplatelet Monotherapy) trial that randomly assigned patients who were event free for 6 to 18 months post-PCI on dual antiplatelet therapy (DAPT) to clopidogrel or aspirin monotherapy. Two clinical risk scores were used for risk stratification: the DAPT score and the Thrombolysis In Myocardial Infarction Risk Score for Secondary Prevention (TRS 2°P) (the sum of age ≥75 years, diabetes, hypertension, current smoking, peripheral artery disease, stroke, coronary artery bypass grafting, heart failure, and renal dysfunction). The primary composite endpoint was a composite of all-cause death, nonfatal myocardial infarction, stroke, readmission because of acute coronary syndrome, and major bleeding (Bleeding Academic Research Consortium type ≥3) at 2 years after randomization.
RESULTS Among 5,403 patients, clopidogrel monotherapy showed a lower rate of the primary composite endpoint than aspirin monotherapy (HR: 0.73; 95% CI: 0.59-0.90). The benefit of clopidogrel over aspirin was consistent regardless of TRS 2°P (high TRS 2°P [≥3] group: HR: 0.65 [95% CI: 0.44-0.96]; and low TRS 2°P [<3] group: HR: 0.77 [95% CI: 0.60-0.99]) (P for interaction = 0.454) and regardless of DAPT score (high DAPT score [≥2] group: HR: 0.68 [95% CI: 0.46-1.00]; and low DAPT score [<2] group: HR: 0.75 [95% CI: 0.59-0.96]) (P for interaction = 0.662). The association was similar for the individual outcomes.
CONCLUSIONS The beneficial effect of clopidogrel over aspirin monotherapy was consistent regardless of clinical risk or relative ischemic and bleeding risks compared with aspirin monotherapy. (Harmonizing Optimal Strategy for Treatment of Coronary Artery Stenosis- EXtended Antiplatelet Monotherapy [HOST-EXAM]; NCT02044250).
Copyright © 2023 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
Keywords
aspirinbleedingclopidogrelischemic eventspercutaneous coronary intervention
Comment · 정정
Conflict of interest statement
Funding Support and Author Disclosures This work was supported by grants from the Patient-Centered Clinical Research Coordinating Center (grant number: HC19C0305). This research was partially supported by a grant from Seoul National University Hospital (Research ID: 30-2021-0030). The study funders had no role in trial design; data collection, analysis, interpretation, writing of the manuscript, or decision to submit the paper for publication. Dr Kim has received research grants or speaker fees from Daiichi-Sankyo, Boston Scientific, Terumo, Biotronik, Dio, Medtronic, Abbott Vascular, Edwards Lifesciences, Amgen, and Boehringer Ingelheim outside of the submitted work. Dr Park has received speaker fees from Daiichi-Sankyo, InnoN Pharmaceutical, and DaeWoong Pharmaceutical outside of the submitted work. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
그 밖의 정보
- 출판 형태
- Randomized Controlled Trial, Journal Article, Research Support, Non-U.S. Gov't
- 저널
- Journal of the American College of Cardiology · eISSN 1558-3597
- MeSH
- Humans · Aged · Clopidogrel / adverse effects · Platelet Aggregation Inhibitors · Percutaneous Coronary Intervention* / adverse effects · Drug Therapy, Combination · Aspirin / adverse effects · Myocardial Infarction* / complications · Hemorrhage / chemically induced / epidemiology / complications · Stroke* / prevention & control · Treatment Outcome
- Substances
- Clopidogrel · Platelet Aggregation Inhibitors · Aspirin
- 데이터
- ClinicalTrials.gov: NCT02044250