P2Y12 inhibitor monotherapy after coronary stenting according to type of P2Y12 inhibitor

Juwon Kim, Woo Jin Jang, Wang Soo Lee, Ki Hong Choi, Joo Myung Lee, Taek Kyu Park, Jeong Hoon Yang, Jin Ho Choi, Young Bin Song, Seung Hyuk Choi, Hyeon Cheol Gwon, Sang Hoon Lee, Ju Hyeon Oh, Woo Jung Chun, Yong Hwan Park, Eul Soon Im, Jin Ok Jeong, Byung Ryul Cho, Seok Kyu Oh, Kyeong Ho YunDeok Kyu Cho, Jong Young Lee, Young Youp Koh, Jang Whan Bae, Jae Woong Choi, Hyuck Jun Yoon, Seung Uk Lee, Jang Hyun Cho, Woong Gil Choi, Seung Woon Rha, Joo Yong Hahn

Research output: Contribution to journalArticlepeer-review

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Abstract

Objective To compare P2Y12 inhibitor monotherapy after 3-month dual antiplatelet therapy (DAPT) with 12-month DAPT according to the type of P2Y12 inhibitor in patients undergoing percutaneous coronary intervention (PCI). Methods The Smart Angioplasty Research Team: Comparison Between P2Y12 Antagonist Monotherapy vs Dual Antiplatelet Therapy in Patients Undergoing Implantation of Coronary Drug-Eluting Stents (SMART-CHOICE) randomised trial compared 3-month DAPT followed by P2Y12 inhibitor monotherapy with 12-month DAPT. In this trial, 2993 patients undergoing successful PCI with drug-eluting stent were enrolled in Korea. As a prespecified analysis, P2Y12 inhibitor monotherapy after 3-month DAPT versus 12-month DAPT were compared among patients receiving clopidogrel and those receiving potent P2Y12 inhibitor (ticagrelor or prasugrel), respectively. The primary endpoint was a composite of all-cause death, myocardial infarction or stroke at 12 months after the index procedure. Results Among 2993 patients (mean age 64 years), 58.2% presented with acute coronary syndrome. Clopidogrel was prescribed in 2312 patients (77.2%) and a potent P2Y12 inhibitor in 681 (22.8%). There were no significant differences in the primary endpoint between the P2Y12 inhibitor monotherapy group and the DAPT group among patients receiving clopidogrel (3.0% vs 3.0%; HR: 1.02; 95% CI 0.64 to 1.65; p=0.93) as well as among patients receiving potent P2Y12 inhibitors (2.4% vs 0.7%; HR: 3.37; 95% CI 0.77 to 14.78; p=0.11; interaction p=0.1). Among patients receiving clopidogrel, P2Y12 inhibitor monotherapy compared with DAPT showed consistent treatment effects across various subgroups for the primary endpoint. Among patients receiving potent P2Y12 inhibitors, the rate of bleeding (Bleeding Academic Research Consortium types 2- 5) was significantly lower in the P2Y12 inhibitor monotherapy group than in the DAPT group (1.5% vs 5.0%; HR: 0.33; 95% CI 0.12 to 0.87; p=0.03). Conclusions Compared with 12-month DAPT, clopidogrel monotherapy after 3-month DAPT showed comparable cardiovascular outcomes in patients undergoing PCI. Trial registration number NCT02079194.

Original languageEnglish
Pages (from-to)1077-1083
Number of pages7
JournalHeart
Volume107
Issue number13
DOIs
Publication statusPublished - 2021 Jul 1
Externally publishedYes

Keywords

  • clinical
  • coronary artery disease
  • percutaneous coronary intervention
  • pharmacology

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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