Vol 28, No 6 (2021)
Original Article
Published online: 2021-09-08

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P2Y12 inhibitor monotherapy in complex percutaneous coronary intervention: A post-hoc analysis of SMART-CHOICE randomized clinical trial

Ji Woong Roh12, Joo-Yong Hahn3, Ju-Hyeon Oh4, Woo Jung Chun4, Yong Hwan Park4, Woo Jin Jang5, Eul-Soon Im6, Jin-Ok Jeong7, Byung Ryul Cho8, Seok Kyu Oh9, Kyeong Ho Yun9, Deok-Kyu Cho1, Jong-Young Lee10, Young-Youp Koh11, Jang-Whan Bae12, Jae Woong Choi13, Wang Soo Lee14, Hyuck Jun Yoon15, Seung Uk Lee16, Jang Hyun Cho17, Woong Gil Choi18, Seung-Woon Rha19, Hee-Yeol Kim1, Joo Myung Lee3, Taek Kyu Park3, Jeong Hoon Yang3, Jin-Ho Choi3, Seung-Hyuck Choi3, Sang Hoon Lee3, Hyeon-Cheol Gwon3, Dong-Bin Kim1, Young Bin Song3
Pubmed: 34523115
Cardiol J 2021;28(6):855-863.


Background: It remains unclear whether P2Y12 monotherapy, especially clopidogrel, following short-duration dual antiplatelet therapy (DAPT) is associated with favorable outcomes in patients undergoing complex percutaneous coronary intervention (PCI). Therefore, this study analyzed the efficacy and safety of P2Y12 inhibitor monotherapy, mostly clopidogrel (78%), in complex PCI following short-term DAPT.
Methods: The post-hoc analysis of the SMART-CHOICE trial involving 2,993 patients included 498 cases of complex PCIs, defined by at least one of the following features: 3 vessels treated, ≥ 3 stents implanted, ≥ 3 lesions treated, bifurcation with ≥ 2 stents implanted, and a total stent length of ≥ 60 mm. The primary endpoint was major adverse cardiac and cerebrovascular event (MACCE), defined as the composite of all-cause death, myocardial infarction, and stroke. The primary safety endpoint included bleeding, defined as Bleeding Academic Research Consortium (BARC) types 2 to 5.
Results: Complex PCI group had a higher risk of MACCE (4.0% vs. 2.3%, hazard ratio [HR] = 1.74, 95% confidence interval [CI]: 1.05–2.89, p = 0.033) and a similar risk of BARC types 2–5 bleeding (2.6% vs. 2.6%, HR = 1.02, 95% CI: 0.56–1.86, p = 0.939) compared with those without complex PCIs. Patients undergoing complex PCIs, followed by P2Y12 inhibitor monotherapy and 12 months of DAPT exhibited similar rates of MACCE (3.8% vs. 4.2%, HR = 0.92, 95% CI: 0.38–2.21, p = 0.853).
Conclusions: P2Y12 inhibitor monotherapy, mostly clopidogrel, following 3 months of DAPT did not increase ischemic events in patients with complex PCIs.

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