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Comparison of Antiplatelet Monotherapies After Percutaneous Coronary Intervention According to Clinical, Ischemic, and Bleeding Risks
Clopidogrel was superior to aspirin monotherapy in secondary prevention after percutaneous coronary intervention (PCI). The purpose of this study was to evaluate the benefits of clopidogrel across high-risk subgroups This was a post hoc analysis of the HOST-EXAM (Harmonizing Optimal Strategy for Tre...
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Published in: | Journal of the American College of Cardiology 2023-10, Vol.82 (16), p.1565-1578 |
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Main Authors: | , , , , , , , , , , , , , , , , , |
Format: | Article |
Language: | English |
Subjects: | |
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Online Access: | Get full text |
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Summary: | Clopidogrel was superior to aspirin monotherapy in secondary prevention after percutaneous coronary intervention (PCI).
The purpose of this study was to evaluate the benefits of clopidogrel across high-risk subgroups
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.
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 [ |
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ISSN: | 0735-1097 1558-3597 |
DOI: | 10.1016/j.jacc.2023.07.031 |