J Korean Med Sci.  2021 Apr;36(16):e106. 10.3346/jkms.2021.36.e106.

Long-term Outcomes of Clopidogrel Monotherapy versus Prolonged Dual Antiplatelet Therapy beyond 12 Months after Percutaneous Coronary Intervention in High-risk Patients

• Kim DY
• Cho SW
• Park KT
• Ahn JH
• Park TK
• Jang YH
• Choi KH
• Lee JM
• Yang JH
• Song YB
• Choi JH
• Choi SH
• Gwon HC
• Lee SH
• Hahn JY

• KMID: 2515087
• DOI: http://doi.org/10.3346/jkms.2021.36.e106

Abstract

Background
There are no data on comparison between clopidogrel monotherapy and prolonged dual antiplatelet therapy (DAPT) in patients at high-risk undergoing percutaneous coronary intervention (PCI).
Methods
Of 2,082 consecutive patients undergoing PCI using second-generation drugeluting stent (DES), we studied 637 patients at high-risk either angiographically or clinically who received clopidogrel longer than 24 months and were event-free at 12 months after index PCI. Patients were divided into 2 groups: the clopidogrel monotherapy group and the prolonged DAPT group. The primary outcome was a composite of all-cause death, non-fatal myocardial infarction (MI), definite or probable stent thrombosis, or stroke between 12 months and 36 months after the index PCI.
Results
In propensity score-matched population (246 pairs), the cumulative rate of primary outcome was 4.5% in the clopidogrel monotherapy group and 4.9% in the prolonged DAPT group (hazard ratio, 1.21; 95% confidence interval, 0.54–2.75; P = 0.643). There was no significant difference in all-cause death, MI, stent thrombosis, stroke between the clopidogrel monotherapy group and the prolonged DAPT group.
Conclusion
Compared with prolonged DAPT, clopidogrel monotherapy showed similar long-term outcomes in patients at high-risk after second-generation DES implantation.

Keyword

Clopidogrel; Dual Antiplatelet Therapy; Percutaneous Coronary Intervention; Drug-eluting Stent

Figure

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  Fig. 1 Study design and population.PCI = percutaneous coronary intervention, DAPT = dual antiplatelet therapy.

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  Fig. 2 Kaplan-Meier survival curves of the (A) overall population and (B) PS-matched population. Analyses starting 12 months after the index percutaneous coronary intervention show event rates of MACCEs.MACCE = major adverse cardiac and cerebrovascular event, DAPT = dual antiplatelet therapy, PS = propensity score.

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