Aspirin Versus Clopidogrel for Long-Term Maintenance Monotherapy After Percutaneous Coronary Intervention: The HOST-EXAM Extended Study
Long-term outcomes of antiplatelet monotherapy in patients who receive percutaneous coronary intervention are unknown. The HOST-EXAM (Harmonizing Optimal Strategy for Treatment of Coronary Artery Stenosis-Extended Antiplatelet Monotherapy) Extended study reports the posttrial follow-up results of th...
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Veröffentlicht in: | Circulation (New York, N.Y.) N.Y.), 2023-01, Vol.147 (2), p.108-117 |
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creator | Kang, Jeehoon Park, Kyung Woo Lee, Huijin Hwang, Doyeon Yang, Han-Mo Rha, Seung-Woon Bae, Jang-Whan Lee, Nam Ho Hur, Seung-Ho Han, Jung-Kyu Shin, Eun-Seok Koo, Bon-Kwon Kim, Hyo-Soo |
description | Long-term outcomes of antiplatelet monotherapy in patients who receive percutaneous coronary intervention are unknown. The HOST-EXAM (Harmonizing Optimal Strategy for Treatment of Coronary Artery Stenosis-Extended Antiplatelet Monotherapy) Extended study reports the posttrial follow-up results of the original HOST-EXAM trial.
From March 2014 through May 2018, 5438 patients who maintained dual antiplatelet therapy without clinical events for 12±6 months after percutaneous coronary intervention with drug-eluting stents were randomly assigned in a 1:1 ratio to receive clopidogrel (75 mg once daily) or aspirin (100 mg once daily). The primary end point (a composite of all-cause death, nonfatal myocardial infarction, stroke, readmission attributable to acute coronary syndrome, and Bleeding Academic Research Consortium type 3 or greater bleeding), secondary thrombotic end point (cardiac death, nonfatal myocardial infarction, ischemic stroke, readmission attributable to acute coronary syndrome, and definite or probable stent thrombosis), and bleeding end point (Bleeding Academic Research Consortium type 2 or greater bleeding) were analyzed during the extended follow-up period. Analysis was performed on the per-protocol population (2431 patients in the clopidogrel group and 2286 patients in the aspirin group).
During a median follow-up of 5.8 years (interquartile range, 4.8-6.2 years), the primary end point occurred in 12.8% and 16.9% in the clopidogrel and aspirin groups, respectively (hazard ratio, 0.74 [95% CI, 0.63-0.86]; |
doi_str_mv | 10.1161/CIRCULATIONAHA.122.062770 |
format | Article |
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From March 2014 through May 2018, 5438 patients who maintained dual antiplatelet therapy without clinical events for 12±6 months after percutaneous coronary intervention with drug-eluting stents were randomly assigned in a 1:1 ratio to receive clopidogrel (75 mg once daily) or aspirin (100 mg once daily). The primary end point (a composite of all-cause death, nonfatal myocardial infarction, stroke, readmission attributable to acute coronary syndrome, and Bleeding Academic Research Consortium type 3 or greater bleeding), secondary thrombotic end point (cardiac death, nonfatal myocardial infarction, ischemic stroke, readmission attributable to acute coronary syndrome, and definite or probable stent thrombosis), and bleeding end point (Bleeding Academic Research Consortium type 2 or greater bleeding) were analyzed during the extended follow-up period. Analysis was performed on the per-protocol population (2431 patients in the clopidogrel group and 2286 patients in the aspirin group).
During a median follow-up of 5.8 years (interquartile range, 4.8-6.2 years), the primary end point occurred in 12.8% and 16.9% in the clopidogrel and aspirin groups, respectively (hazard ratio, 0.74 [95% CI, 0.63-0.86];
<0.001). The clopidogrel group had a lower risk for the secondary thrombotic end point (7.9% versus 11.9%; hazard ratio, 0.66 [95% CI, 0.55-0.79];
<0.001) and secondary bleeding end point (4.5% versus 6.1%; hazard ratio, 0.74 [95% CI, 0.57-0.94];
=0.016). There was no significant difference in the incidence of all-cause death between the 2 groups (6.2% versus 6.0%; hazard ratio, 1.04 [95% CI, 0.82-1.31];
=0.742). Landmark analysis at 2 years showed that the beneficial effect of clopidogrel was consistent throughout the follow-up period.
During an extended follow-up of >5 years after randomization, clopidogrel monotherapy compared with aspirin monotherapy was associated with lower rates of the composite net clinical outcome in patients without clinical events for 12±6 months after percutaneous coronary intervention with drug-eluting stents.
URL: https://www.
gov; Unique identifier: NCT02044250.</description><identifier>ISSN: 0009-7322</identifier><identifier>EISSN: 1524-4539</identifier><identifier>DOI: 10.1161/CIRCULATIONAHA.122.062770</identifier><identifier>PMID: 36342475</identifier><language>eng</language><publisher>United States: Lippincott Williams & Wilkins</publisher><subject>Acute Coronary Syndrome - drug therapy ; Acute Coronary Syndrome - surgery ; Aspirin - adverse effects ; Clopidogrel - therapeutic use ; Drug Therapy, Combination ; Hemorrhage - chemically induced ; Hemorrhage - drug therapy ; Humans ; Myocardial Infarction - drug therapy ; Myocardial Infarction - epidemiology ; Percutaneous Coronary Intervention - adverse effects ; Platelet Aggregation Inhibitors - adverse effects ; Thrombosis - drug therapy ; Treatment Outcome</subject><ispartof>Circulation (New York, N.Y.), 2023-01, Vol.147 (2), p.108-117</ispartof><rights>Lippincott Williams & Wilkins</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4792-d160421a6adb6f594b775784ce8c929524b0869dcf3a0b77508fbd59136143ad3</citedby><cites>FETCH-LOGICAL-c4792-d160421a6adb6f594b775784ce8c929524b0869dcf3a0b77508fbd59136143ad3</cites><orcidid>0000-0002-1548-2351 ; 0000-0002-9169-6968 ; 0000-0003-1362-9804 ; 0000-0002-8188-3348 ; 0000-0002-0016-0747 ; 0000-0002-0215-5319 ; 0000-0003-0847-5329 ; 0000-0003-2432-4432</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,777,781,3674,27905,27906</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36342475$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kang, Jeehoon</creatorcontrib><creatorcontrib>Park, Kyung Woo</creatorcontrib><creatorcontrib>Lee, Huijin</creatorcontrib><creatorcontrib>Hwang, Doyeon</creatorcontrib><creatorcontrib>Yang, Han-Mo</creatorcontrib><creatorcontrib>Rha, Seung-Woon</creatorcontrib><creatorcontrib>Bae, Jang-Whan</creatorcontrib><creatorcontrib>Lee, Nam Ho</creatorcontrib><creatorcontrib>Hur, Seung-Ho</creatorcontrib><creatorcontrib>Han, Jung-Kyu</creatorcontrib><creatorcontrib>Shin, Eun-Seok</creatorcontrib><creatorcontrib>Koo, Bon-Kwon</creatorcontrib><creatorcontrib>Kim, Hyo-Soo</creatorcontrib><title>Aspirin Versus Clopidogrel for Long-Term Maintenance Monotherapy After Percutaneous Coronary Intervention: The HOST-EXAM Extended Study</title><title>Circulation (New York, N.Y.)</title><addtitle>Circulation</addtitle><description>Long-term outcomes of antiplatelet monotherapy in patients who receive percutaneous coronary intervention are unknown. The HOST-EXAM (Harmonizing Optimal Strategy for Treatment of Coronary Artery Stenosis-Extended Antiplatelet Monotherapy) Extended study reports the posttrial follow-up results of the original HOST-EXAM trial.
From March 2014 through May 2018, 5438 patients who maintained dual antiplatelet therapy without clinical events for 12±6 months after percutaneous coronary intervention with drug-eluting stents were randomly assigned in a 1:1 ratio to receive clopidogrel (75 mg once daily) or aspirin (100 mg once daily). The primary end point (a composite of all-cause death, nonfatal myocardial infarction, stroke, readmission attributable to acute coronary syndrome, and Bleeding Academic Research Consortium type 3 or greater bleeding), secondary thrombotic end point (cardiac death, nonfatal myocardial infarction, ischemic stroke, readmission attributable to acute coronary syndrome, and definite or probable stent thrombosis), and bleeding end point (Bleeding Academic Research Consortium type 2 or greater bleeding) were analyzed during the extended follow-up period. Analysis was performed on the per-protocol population (2431 patients in the clopidogrel group and 2286 patients in the aspirin group).
During a median follow-up of 5.8 years (interquartile range, 4.8-6.2 years), the primary end point occurred in 12.8% and 16.9% in the clopidogrel and aspirin groups, respectively (hazard ratio, 0.74 [95% CI, 0.63-0.86];
<0.001). The clopidogrel group had a lower risk for the secondary thrombotic end point (7.9% versus 11.9%; hazard ratio, 0.66 [95% CI, 0.55-0.79];
<0.001) and secondary bleeding end point (4.5% versus 6.1%; hazard ratio, 0.74 [95% CI, 0.57-0.94];
=0.016). There was no significant difference in the incidence of all-cause death between the 2 groups (6.2% versus 6.0%; hazard ratio, 1.04 [95% CI, 0.82-1.31];
=0.742). Landmark analysis at 2 years showed that the beneficial effect of clopidogrel was consistent throughout the follow-up period.
During an extended follow-up of >5 years after randomization, clopidogrel monotherapy compared with aspirin monotherapy was associated with lower rates of the composite net clinical outcome in patients without clinical events for 12±6 months after percutaneous coronary intervention with drug-eluting stents.
URL: https://www.
gov; Unique identifier: NCT02044250.</description><subject>Acute Coronary Syndrome - drug therapy</subject><subject>Acute Coronary Syndrome - surgery</subject><subject>Aspirin - adverse effects</subject><subject>Clopidogrel - therapeutic use</subject><subject>Drug Therapy, Combination</subject><subject>Hemorrhage - chemically induced</subject><subject>Hemorrhage - drug therapy</subject><subject>Humans</subject><subject>Myocardial Infarction - drug therapy</subject><subject>Myocardial Infarction - epidemiology</subject><subject>Percutaneous Coronary Intervention - adverse effects</subject><subject>Platelet Aggregation Inhibitors - adverse effects</subject><subject>Thrombosis - drug therapy</subject><subject>Treatment Outcome</subject><issn>0009-7322</issn><issn>1524-4539</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpVkd2O0zAQhS0EYsvCKyBzx02KfxI74S6qCq3UUsRmEXeWE0-2gdTO2glLn4DXxlUWJK5Gts8545kPoTeULCkV9N1q-2V1uyur7eFTuSmXlLElEUxK8gQtaMbSJM148RQtCCFFIjljV-hFCN_jUXCZPUdXXPCUpTJboN9lGDrfWfwVfJgCXvVu6Iy789Dj1nm8c_YuqcCf8F53dgSrbQN476wbj-D1cMZlO4LHn8E306gtuEuI885qf8bb6PA_wY6ds-9xdQS8OdxUyfpbucfrXzHNgME342TOL9GzVvcBXj3Wa3T7YV2tNsnu8HG7KndJk8qCJYYKkjKqhTa1aLMiraXMZJ42kDcFK-LsNclFYZqWa3J5I3lbm6ygXNCUa8Ov0ds5d_DufoIwqlMXGuj7-euKSc4ZybjIo7SYpY13IXho1eC7UxxLUaIuHNT_HFTkoGYO0fv6sc1Un8D8c_5dfBSks-DB9XFH4Uc_PYBXR9D9eFSRFOGEyoQRFislJLlcMf4H3PGV0Q</recordid><startdate>20230110</startdate><enddate>20230110</enddate><creator>Kang, Jeehoon</creator><creator>Park, Kyung Woo</creator><creator>Lee, Huijin</creator><creator>Hwang, Doyeon</creator><creator>Yang, Han-Mo</creator><creator>Rha, Seung-Woon</creator><creator>Bae, Jang-Whan</creator><creator>Lee, Nam Ho</creator><creator>Hur, Seung-Ho</creator><creator>Han, Jung-Kyu</creator><creator>Shin, Eun-Seok</creator><creator>Koo, Bon-Kwon</creator><creator>Kim, Hyo-Soo</creator><general>Lippincott Williams & Wilkins</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-1548-2351</orcidid><orcidid>https://orcid.org/0000-0002-9169-6968</orcidid><orcidid>https://orcid.org/0000-0003-1362-9804</orcidid><orcidid>https://orcid.org/0000-0002-8188-3348</orcidid><orcidid>https://orcid.org/0000-0002-0016-0747</orcidid><orcidid>https://orcid.org/0000-0002-0215-5319</orcidid><orcidid>https://orcid.org/0000-0003-0847-5329</orcidid><orcidid>https://orcid.org/0000-0003-2432-4432</orcidid></search><sort><creationdate>20230110</creationdate><title>Aspirin Versus Clopidogrel for Long-Term Maintenance Monotherapy After Percutaneous Coronary Intervention: The HOST-EXAM Extended Study</title><author>Kang, Jeehoon ; Park, Kyung Woo ; Lee, Huijin ; Hwang, Doyeon ; Yang, Han-Mo ; Rha, Seung-Woon ; Bae, Jang-Whan ; Lee, Nam Ho ; Hur, Seung-Ho ; Han, Jung-Kyu ; Shin, Eun-Seok ; Koo, Bon-Kwon ; Kim, Hyo-Soo</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4792-d160421a6adb6f594b775784ce8c929524b0869dcf3a0b77508fbd59136143ad3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Acute Coronary Syndrome - drug therapy</topic><topic>Acute Coronary Syndrome - surgery</topic><topic>Aspirin - adverse effects</topic><topic>Clopidogrel - therapeutic use</topic><topic>Drug Therapy, Combination</topic><topic>Hemorrhage - chemically induced</topic><topic>Hemorrhage - drug therapy</topic><topic>Humans</topic><topic>Myocardial Infarction - drug therapy</topic><topic>Myocardial Infarction - epidemiology</topic><topic>Percutaneous Coronary Intervention - adverse effects</topic><topic>Platelet Aggregation Inhibitors - adverse effects</topic><topic>Thrombosis - drug therapy</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Kang, Jeehoon</creatorcontrib><creatorcontrib>Park, Kyung Woo</creatorcontrib><creatorcontrib>Lee, Huijin</creatorcontrib><creatorcontrib>Hwang, Doyeon</creatorcontrib><creatorcontrib>Yang, Han-Mo</creatorcontrib><creatorcontrib>Rha, Seung-Woon</creatorcontrib><creatorcontrib>Bae, Jang-Whan</creatorcontrib><creatorcontrib>Lee, Nam Ho</creatorcontrib><creatorcontrib>Hur, Seung-Ho</creatorcontrib><creatorcontrib>Han, Jung-Kyu</creatorcontrib><creatorcontrib>Shin, Eun-Seok</creatorcontrib><creatorcontrib>Koo, Bon-Kwon</creatorcontrib><creatorcontrib>Kim, Hyo-Soo</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Circulation (New York, N.Y.)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kang, Jeehoon</au><au>Park, Kyung Woo</au><au>Lee, Huijin</au><au>Hwang, Doyeon</au><au>Yang, Han-Mo</au><au>Rha, Seung-Woon</au><au>Bae, Jang-Whan</au><au>Lee, Nam Ho</au><au>Hur, Seung-Ho</au><au>Han, Jung-Kyu</au><au>Shin, Eun-Seok</au><au>Koo, Bon-Kwon</au><au>Kim, Hyo-Soo</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Aspirin Versus Clopidogrel for Long-Term Maintenance Monotherapy After Percutaneous Coronary Intervention: The HOST-EXAM Extended Study</atitle><jtitle>Circulation (New York, N.Y.)</jtitle><addtitle>Circulation</addtitle><date>2023-01-10</date><risdate>2023</risdate><volume>147</volume><issue>2</issue><spage>108</spage><epage>117</epage><pages>108-117</pages><issn>0009-7322</issn><eissn>1524-4539</eissn><abstract>Long-term outcomes of antiplatelet monotherapy in patients who receive percutaneous coronary intervention are unknown. The HOST-EXAM (Harmonizing Optimal Strategy for Treatment of Coronary Artery Stenosis-Extended Antiplatelet Monotherapy) Extended study reports the posttrial follow-up results of the original HOST-EXAM trial.
From March 2014 through May 2018, 5438 patients who maintained dual antiplatelet therapy without clinical events for 12±6 months after percutaneous coronary intervention with drug-eluting stents were randomly assigned in a 1:1 ratio to receive clopidogrel (75 mg once daily) or aspirin (100 mg once daily). The primary end point (a composite of all-cause death, nonfatal myocardial infarction, stroke, readmission attributable to acute coronary syndrome, and Bleeding Academic Research Consortium type 3 or greater bleeding), secondary thrombotic end point (cardiac death, nonfatal myocardial infarction, ischemic stroke, readmission attributable to acute coronary syndrome, and definite or probable stent thrombosis), and bleeding end point (Bleeding Academic Research Consortium type 2 or greater bleeding) were analyzed during the extended follow-up period. Analysis was performed on the per-protocol population (2431 patients in the clopidogrel group and 2286 patients in the aspirin group).
During a median follow-up of 5.8 years (interquartile range, 4.8-6.2 years), the primary end point occurred in 12.8% and 16.9% in the clopidogrel and aspirin groups, respectively (hazard ratio, 0.74 [95% CI, 0.63-0.86];
<0.001). The clopidogrel group had a lower risk for the secondary thrombotic end point (7.9% versus 11.9%; hazard ratio, 0.66 [95% CI, 0.55-0.79];
<0.001) and secondary bleeding end point (4.5% versus 6.1%; hazard ratio, 0.74 [95% CI, 0.57-0.94];
=0.016). There was no significant difference in the incidence of all-cause death between the 2 groups (6.2% versus 6.0%; hazard ratio, 1.04 [95% CI, 0.82-1.31];
=0.742). Landmark analysis at 2 years showed that the beneficial effect of clopidogrel was consistent throughout the follow-up period.
During an extended follow-up of >5 years after randomization, clopidogrel monotherapy compared with aspirin monotherapy was associated with lower rates of the composite net clinical outcome in patients without clinical events for 12±6 months after percutaneous coronary intervention with drug-eluting stents.
URL: https://www.
gov; Unique identifier: NCT02044250.</abstract><cop>United States</cop><pub>Lippincott Williams & Wilkins</pub><pmid>36342475</pmid><doi>10.1161/CIRCULATIONAHA.122.062770</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0002-1548-2351</orcidid><orcidid>https://orcid.org/0000-0002-9169-6968</orcidid><orcidid>https://orcid.org/0000-0003-1362-9804</orcidid><orcidid>https://orcid.org/0000-0002-8188-3348</orcidid><orcidid>https://orcid.org/0000-0002-0016-0747</orcidid><orcidid>https://orcid.org/0000-0002-0215-5319</orcidid><orcidid>https://orcid.org/0000-0003-0847-5329</orcidid><orcidid>https://orcid.org/0000-0003-2432-4432</orcidid><oa>free_for_read</oa></addata></record> |
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source | MEDLINE; American Heart Association Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Journals@Ovid Ovid Autoload |
subjects | Acute Coronary Syndrome - drug therapy Acute Coronary Syndrome - surgery Aspirin - adverse effects Clopidogrel - therapeutic use Drug Therapy, Combination Hemorrhage - chemically induced Hemorrhage - drug therapy Humans Myocardial Infarction - drug therapy Myocardial Infarction - epidemiology Percutaneous Coronary Intervention - adverse effects Platelet Aggregation Inhibitors - adverse effects Thrombosis - drug therapy Treatment Outcome |
title | Aspirin Versus Clopidogrel for Long-Term Maintenance Monotherapy After Percutaneous Coronary Intervention: The HOST-EXAM Extended Study |
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