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
Hauptverfasser: 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
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container_issue 2
container_start_page 108
container_title Circulation (New York, N.Y.)
container_volume 147
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
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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]; &lt;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]; &lt;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 &gt;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 &amp; 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 &amp; 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]; &lt;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]; &lt;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 &gt;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. 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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 ; 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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]; &lt;0.001). 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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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