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Original research
P2Y12 inhibitor monotherapy after coronary stenting according to type of P2Y12 inhibitor
  1. Juwon Kim1,
  2. Woo Jin Jang2,
  3. Wang Soo Lee3,
  4. Ki Hong Choi1,
  5. Joo Myung Lee1,
  6. Taek Kyu Park1,
  7. Jeong Hoon Yang1,
  8. Jin-Ho Choi1,
  9. Young Bin Song1,
  10. Seung-Hyuk Choi1,
  11. Hyeon-Cheol Gwon1,
  12. Sang Hoon Lee1,
  13. Ju-Hyeon Oh4,
  14. Woo Jung Chun4,
  15. Yong Hwan Park4,
  16. Eul-Soon Im5,
  17. Jin-Ok Jeong6,
  18. Byung Ryul Cho7,
  19. Seok Kyu Oh8,
  20. Kyeong Ho Yun8,
  21. Deok-Kyu Cho9,
  22. Jong-Young Lee10,
  23. Young-Youp Koh11,
  24. Jang-Whan Bae12,
  25. Jae Woong Choi13,
  26. Hyuck Jun Yoon14,
  27. Seung Uk Lee15,
  28. Jang Hyun Cho16,
  29. Woong Gil Choi17,
  30. Seung-Woon Rha18,
  31. Joo-Yong Hahn1
  1. 1 Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of)
  2. 2 Division of Cardiology, Department of Internal Medicine, Ewha Womans University College of Medicine Seoul Hospital, Seoul, Korea (the Republic of)
  3. 3 Department of Cardiology, Chung-Ang University Hospital, Seoul, Korea (the Republic of)
  4. 4 Department of Cardiology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of)
  5. 5 Division of Cardiology, Dongsuwon General Hospital, Suwon, Korea (the Republic of)
  6. 6 Department of Cardiology, Chungnam National University Hospital, Daejeon, Korea (the Republic of)
  7. 7 Department of Cardiology, Kangwon National University Hospital, Chuncheon, Korea (the Republic of)
  8. 8 Department of Cardiology, Wonkwang University Hospital, Iksan, Korea (the Republic of)
  9. 9 Department of Cardiology, Myongji Hospital, Goyang, Korea (the Republic of)
  10. 10 Department of Cardiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of)
  11. 11 Department of Cardiology, Chosun University Hospital, Gwangju, Korea (the Republic of)
  12. 12 Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Korea (the Republic of)
  13. 13 Division of Cardiology, Seoul Eulji Hospital, Eulji University College of Medicine, Seoul, Korea (the Republic of)
  14. 14 Department of Cardiology, Keimyung University Dongsan Medical Center, Daegu, Korea (the Republic of)
  15. 15 Department of Cardiology, Kwangju Christian Hospital, Gwangju, Korea (the Republic of)
  16. 16 Division of Cardiology, Saint Carollo Hospital, Suncheon, Korea (the Republic of)
  17. 17 Department of Cardiology, Konkuk University Chungju Hospital, Chungju, Korea (the Republic of)
  18. 18 Department of Cardiology, Korea University Guro Hospital, Seoul, Korea (the Republic of)
  1. Correspondence to Dr Joo-Yong Hahn, Cardiology, Samsung Medical Center, Seoul 135-710, Korea (the Republic of); jyhahn{at}skku.edu; Dr Wang Soo Lee, Cardiology, Chung-Ang University Hospital, Seoul, Korea (the Republic of); wangsoolee{at}gmail.com

Abstract

Objective To compare P2Y12 inhibitor monotherapy after 3-month dual antiplatelet therapy (DAPT) with 12-month DAPT according to the type of P2Y12 inhibitor in patients undergoing percutaneous coronary intervention (PCI).

Methods The Smart Angioplasty Research Team: Comparison Between P2Y12 Antagonist Monotherapy vs Dual Antiplatelet Therapy in Patients Undergoing Implantation of Coronary Drug-Eluting Stents (SMART-CHOICE) randomised trial compared 3-month DAPT followed by P2Y12 inhibitor monotherapy with 12-month DAPT. In this trial, 2993 patients undergoing successful PCI with drug-eluting stent were enrolled in Korea. As a prespecified analysis, P2Y12 inhibitor monotherapy after 3-month DAPT versus 12-month DAPT were compared among patients receiving clopidogrel and those receiving potent P2Y12 inhibitor (ticagrelor or prasugrel), respectively. The primary endpoint was a composite of all-cause death, myocardial infarction or stroke at 12 months after the index procedure.

Results Among 2993 patients (mean age 64 years), 58.2% presented with acute coronary syndrome. Clopidogrel was prescribed in 2312 patients (77.2%) and a potent P2Y12 inhibitor in 681 (22.8%). There were no significant differences in the primary endpoint between the P2Y12 inhibitor monotherapy group and the DAPT group among patients receiving clopidogrel (3.0% vs 3.0%; HR: 1.02; 95% CI 0.64 to 1.65; p=0.93) as well as among patients receiving potent P2Y12 inhibitors (2.4% vs 0.7%; HR: 3.37; 95% CI 0.77 to 14.78; p=0.11; interaction p=0.1). Among patients receiving clopidogrel, P2Y12 inhibitor monotherapy compared with DAPT showed consistent treatment effects across various subgroups for the primary endpoint. Among patients receiving potent P2Y12 inhibitors, the rate of bleeding (Bleeding Academic Research Consortium types 2– 5) was significantly lower in the P2Y12 inhibitor monotherapy group than in the DAPT group (1.5% vs 5.0%; HR: 0.33; 95% CI 0.12 to 0.87; p=0.03).

Conclusions Compared with 12-month DAPT, clopidogrel monotherapy after 3-month DAPT showed comparable cardiovascular outcomes in patients undergoing PCI.

Trial registration number NCT02079194.

  • percutaneous coronary intervention
  • coronary artery disease
  • pharmacology
  • clinical

Data availability statement

No additional data available.

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Footnotes

  • JK and WJJ contributed equally.

  • Contributors Concept and design: JK, WJJ, J-YH, WSL, KHC, YBS, J-YL, Y-YK, JWC, JML, TKP, JHY, J-HC, S-HC and H-CG. Acquisition, analysis or interpretation of data: JK, WJJ, J-YH, YBS, J-HO, WJC, YHP, E-SI, J-OJ, BRC, SKO, KHY, D-KC, J-WB, WSL, HJY, SUL, JHC, WGC, S-WR, JML, TKP, JHY, S-HC, SHL, H-CG. Drafting of the manuscript: JK, WJJ, KHC, J-YH, YBS, J-YL, Y-YK, JWC, WGC, JML, J-HC, H-CG. Critical revision of the manuscript for important intellectual content: J-YH, WSL, YBS, J-HO, WJC, YHP, E-SI, J-OJ, BRC, SKO, KHY, D-KC, J-WB, HJY, SUL, JHC, S-WR, JML, TKP, JHY, S-HC, SHL, H-CG. Statistical analysis: JK, WJJ, KHC, YBS, JML, TKP, J-HC, H-CG. J-YH is the guarantor.

  • Funding This study was supported by grants from the Korean Society of Interventional Cardiology (grant 2013-3), Abbott Vascular, Biotronik, Boston Scientific and the Korea Health Technology R&D Project through the Korea Health Industry Development Institute funded by the Ministry of Health & Welfare, Republic of Korea (grant number: HI10C2020).

  • Disclaimer J-YH reports receiving grants from Abbott Vascular, Boston Scientific, Biotronik, Korean Society of Interventional Cardiology, and Medtronic; and speaker’s fees from AstraZeneca, Daiichi Sankyo, and sanofi-aventis. H-CG reports receiving research grants from Abbott Vascular, Boston Scientific, and Medtronic; and speaker’s fees from Abbott Vascular, Boston Scientific, and Medtronic.

  • Competing interests J-YH reports receiving grants from Abbott Vascular, Boston Scientific, Biotronik, Korean Society of Interventional Cardiology, and Medtronic; and speaker’s fees from AstraZeneca, Daiichi Sankyo and Sanofi-Aventis. H-CG reports receiving research grants from Abbott Vascular, Boston Scientific and Medtronic; and speaker’s fees from Abbott Vascular, Boston Scientific and Medtronic. All other authors declare that they have no conflicts of interest.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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