Korean Circ J.  2020 Feb;50(2):120-129. 10.4070/kcj.2019.0166.

Clopidogrel versus Aspirin after Dual Antiplatelet Therapy in Acute Myocardial Infarction Patients Undergoing Drug-Eluting Stenting

Affiliations
  • 1Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea. myungho@chollian.net
  • 2Department of Cardiology, Seoul National University Hospital, Seoul, Korea.
  • 3Department of Cardiology, Samsung Medical Center, Sungkyunkwan University, Seoul, Korea.
  • 4Department of Cardiology, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.
  • 5Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea.
  • 6Department of Cardiology, Kyungpook National University Hospital, Daegu, Korea.
  • 7Department of Cardiology, Kyung Hee University Hospital at Gangdong, Seoul, Korea.
  • 8Department of Cardiology, Pusan National University Hospital, Busan, Korea.
  • 9Division of Cardiology, Yeungnam University Hospital, Daegu, Korea.
  • 10Division of Cardiology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea.
  • 11Department of Cardiology, Chunbuk National University Hospital, Jeonju, Korea.
  • 12Department of Cardiology, Jeju National University Hospital, Jeju, Korea.
  • 13Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea.
  • 14Department of Cardiology, Keimyung University Dongsan Medical Center, Daegu, Korea.
  • 15Department of Cardiology, Chungnam National University Hospital, Daejeon, Korea.
  • 16Department of Cardiology, Chungbuk National University Hospital, Cheongju, Korea.
  • 17Department of Cardiology, Inje University Haeundae Paik Hospital, Busan, Korea.
  • 18Department of Cardiology, Wonkwang University Hospital, Iksan, Korea.
  • 19Department of Cardiology, Gachon University Gil Medical Center, Incheon, Korea.
  • 20Department of Cardiology, Kyungsang National University Hospital, Jinju, Korea.

Abstract

BACKGROUND AND OBJECTIVES
There is a paucity of data regarding the benefit of clopidogrel monotherapy after dual antiplatelet therapy (DAPT) in patients treated with drug-eluting stents (DES). This study compared outcome between clopidogrel versus aspirin as monotherapy after DES for acute myocardial infarction (MI).
METHODS
From Korea Acute Myocardial Infarction Registry-National Institute of Health database, 1,819 patients treated with DES who were switched to monotherapy with clopidogrel (n=534) or aspirin (n=1,285) after uneventful 12-month DAPT were analyzed. The primary endpoint was net adverse clinical events (NACE), defined as a composite of death from any cause, MI, repeat percutaneous coronary intervention (PCI), stent thrombosis, ischemic stroke, or major bleeding during the period from 12 to 24 months.
RESULTS
After adjustment using inverse probability of treatment weighting, patients who received clopidogrel, compared with those treated with aspirin, had a similar incidence of NACE (0.7% and 0.7%; hazard ratio, 1.06; 95% confidence interval, 0.31-3.60; p=0.923). The 2 groups had similar rates of death from any cause (0.1% in each group, p=0.789), MI (0.3% and 0.1%, respectively; p=0.226), repeat PCI (0.1% and 0.3%, respectively; p=0.548), stent thrombosis (0.1% and 0%, respectively; p=0.121), major bleeding (0.2% in each group, p=0.974), and major adverse cardiovascular and cerebrovascular events (0.5% in each group, p=0.924).
CONCLUSIONS
Monotherapy with clopidogrel, compared to aspirin, after DAPT showed similar clinical outcomes in patients with acute MI treated with DES.

Keyword

Antiplatelet agents; Drug-eluting stents; Myocardial infarction

MeSH Terms

Aspirin*
Drug-Eluting Stents
Hemorrhage
Humans
Incidence
Korea
Myocardial Infarction*
Percutaneous Coronary Intervention
Platelet Aggregation Inhibitors
Stents*
Stroke
Thrombosis
Aspirin
Platelet Aggregation Inhibitors
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