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

Ji Woong Roh, Joo-Yong Hahn, Ju-Hyeon Oh, Woo Jung Chun, Yong Hwan Park, Woo Jin Jang, Eul-Soon Im, Jin-Ok Jeong, Byung Ryul Cho, Seok Kyu Oh, Kyeong Ho Yun, Deok-Kyu Cho, Jong-Young Lee, Young-Youp Koh, Jang-Whan Bae, Jae Woong Choi, Wang Soo Lee, Hyuck Jun Yoon, Seung Uk Lee, Jang Hyun Cho, Woong Gil Choi, Seung-Woon Rha, Hee-Yeol Kim, Joo Myung Lee, Taek Kyu Park, Jeong Hoon Yang, Jin-Ho Choi, Seung-Hyuck Choi, Sang Hoon Lee, Hyeon-Cheol Gwon, Dong-Bin Kim, Young Bin Song
DOI: 10.5603/CJ.a2021.0101
·
Pubmed: 34523115

open access

Ahead of print
Original articles
Published online: 2021-09-08

Abstract

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.

Abstract

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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Keywords

clopidogrel, high-risk, percutaneous coronary intervention

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Supplementary Table 1. Comparison of clinical outcomes in patients with complex PCI stratified according to bleeding risk
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About this article
Title

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

Journal

Cardiology Journal

Issue

Ahead of print

Article type

Original Article

Published online

2021-09-08

DOI

10.5603/CJ.a2021.0101

Pubmed

34523115

Keywords

clopidogrel
high-risk
percutaneous coronary intervention

Authors

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

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