Comparison of Antiplatelet Monotherapies After Percutaneous Coronary Intervention According to Clinical, Ischemic, and Bleeding Risks.
J Am Coll Cardiol
; 82(16): 1565-1578, 2023 10 17.
Article
en En
| MEDLINE
| ID: mdl-37821166
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 subgroupsMETHODS:
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).Palabras clave
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Accidente Cerebrovascular
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Intervención Coronaria Percutánea
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Infarto del Miocardio
Tipo de estudio:
Clinical_trials
/
Etiology_studies
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Risk_factors_studies
Límite:
Aged
/
Humans
Idioma:
En
Revista:
J Am Coll Cardiol
Año:
2023
Tipo del documento:
Article