P2Y12 inhibitor monotherapy after coronary stenting according to type of P2Y12 inhibitor

被引：4

作者：

Kim, Juwon ^{[1
]}

Jang, Woo Jin ^{[2
]}

Lee, Wang Soo ^{[3
]}

Choi, Ki Hong ^{[1
]}

Lee, Joo Myung ^{[1
]}

Park, Taek Kyu ^{[1
]}

Yang, Jeong Hoon ^{[1
]}

Choi, Jin-Ho ^{[1
]}

Bin Song, Young ^{[1
]}

Choi, Seung-Hyuk ^{[1
]}

Gwon, Hyeon-Cheol ^{[1
]}

Lee, Sang Hoon ^{[1
]}

Oh, Ju-Hyeon ^{[4
]}

Chun, Woo Jung ^{[4
]}

Park, Yong Hwan ^{[4
]}

Im, Eul-Soon ^{[5
]}

Jeong, Jin-Ok ^{[6
]}

Cho, Byung Ryul ^{[7
]}

Oh, Seok Kyu ^{[8
]}

Yun, Kyeong Ho ^{[8
]}

Cho, Deok-Kyu ^{[9
]}

Lee, Jong-Young ^{[10
]}

Koh, Young-Youp ^{[11
]}

Bae, Jang-Whan ^{[12
]}

Choi, Jae Woong ^{[13
]}

Yoon, Hyuck Jun ^{[14
]}

Lee, Seung Uk ^{[15
]}

Cho, Jang Hyun ^{[16
]}

Choi, Woong Gil ^{[17
]}

Rha, Seung-Woon ^{[18
]}

Hahn, Joo-Yong ^{[1
]}

机构：

[1] Sungkyunkwan Univ, Samsung Med Ctr, Dept Med, Sch Med,Div Cardiol, Seoul, South Korea

[2] Ewha Womans Univ, Dept Internal Med, Div Cardiol, Coll Med,Seoul Hosp, Seoul, South Korea

[3] Chung Ang Univ Hosp, Dept Cardiol, Seoul, South Korea

[4] Sungkyunkwan Univ, Samsung Changwon Hosp, Dept Cardiol, Sch Med, Seoul, South Korea

[5] Dongsuwon Gen Hosp, Div Cardiol, Suwon, South Korea

[6] Chungnam Natl Univ Hosp, Dept Cardiol, Daejeon, South Korea

[7] Kangwon Natl Univ Hosp, Dept Cardiol, Chunchon, South Korea

[8] Wonkwang Univ Hosp, Dept Cardiol, Iksan, South Korea

[9] Myongji Hosp, Dept Cardiol, Goyang, South Korea

[10] Sungkyunkwan Univ, Kangbuk Samsung Hosp, Dept Cardiol, Sch Med, Seoul, South Korea

[11] Chosun Univ Hosp, Dept Cardiol, Gwangju, South Korea

[12] Chungbuk Natl Univ Hosp, Dept Internal Med, Div Cardiol, Cheongju, South Korea

[13] Eulji Univ, Seoul Eulji Hosp, Div Cardiol, Coll Med, Seoul, South Korea

[14] Keimyung Univ, Dept Cardiol, Dongsan Med Ctr, Daegu, South Korea

[15] Kwangju Christian Hosp, Dept Cardiol, Gwangju, South Korea

[16] St Carollo Hosp, Div Cardiol, Sunchon, South Korea

[17] Konkuk Univ, Dept Cardiol, Chungju Hosp, Chungju, South Korea

[18] Korea Univ, Dept Cardiol, Guro Hosp, Seoul, South Korea

来源：

HEART | 2021年 / 107卷 / 13期

关键词：

percutaneous coronary intervention; coronary artery disease; pharmacology; clinical; DUAL ANTIPLATELET THERAPY; PLATELET REACTIVITY; SMART-CHOICE; CLOPIDOGREL; IMPLANTATION; INTERVENTION; TICAGRELOR; PRASUGREL; ASPIRIN; EVENTS;

D O I：

10.1136/heartjnl-2020-318821

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

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.

引用

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页码：1077 / 1083

页数：7

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