Article Impact Level: HIGH Data Quality: STRONG Summary of JAMA Cardiology. https://doi.org/10.1001/jamacardio.2023.0592 Dr. Tae-Min Rhee et al.
Points
- The optimal antiplatelet agent in patients who have undergone percutaneous coronary intervention is essential in those with diabetes due to the heightened risk of ischemic events in this population.
- This study investigates cardiovascular outcomes with clopidogrel vs. aspirin in patients with and without diabetes who have received dual antiplatelet therapy without clinical events for 6 to 18 months after percutaneous coronary intervention with drug-eluting stents.
- The study found that clopidogrel monotherapy was associated with a lower rate of the primary composite endpoint compared to aspirin monotherapy as long-term maintenance therapy after dual antiplatelet therapy for coronary stenting in both patients with and without diabetes.
- The primary composite endpoint was defined as all-cause death, nonfatal myocardial infarction, stroke, readmission due to acute coronary syndrome, and significant bleeding (Bleeding Academic Research Consortium type 3 or 5) at 24-month follow-up.
- Clopidogrel might thus be considered rather than aspirin in patients who have undergone coronary stenting and completed dual antiplatelet therapy, regardless of diabetes status.
Summary
The study investigated the efficacy and safety of clopidogrel versus aspirin as long-term maintenance therapy after dual antiplatelet therapy for coronary stenting in patients with and without diabetes. The researchers conducted a post hoc analysis of the HOST-EXAM randomized clinical trial, which enrolled patients who had received dual antiplatelet therapy without clinical events for 6 to 18 months after percutaneous coronary intervention with drug-eluting stents. A total of 5438 patients were included in the analysis; 1860 (34.2%) had diabetes.
The primary composite endpoint of all-cause death, nonfatal myocardial infarction, stroke, readmission due to acute coronary syndrome, and significant bleeding at 24-month follow-up was significantly lower in the clopidogrel group compared to the aspirin group in both patients with diabetes (6.3% vs. 9.2%) and without diabetes (5.3% vs. 7.0%). The hazard ratios were 0.69 (95% CI, 0.49-0.96; P = .03) and 0.76 (95% CI, 0.58-1.00; P = .046), respectively. The absolute risk difference was 2.7% and 1.6%, and the number needed to treat was 37 and 63, respectively. There was no significant difference in the benefit observed with clopidogrel monotherapy over aspirin for the thrombotic composite endpoint and any bleeding with Bleeding Academic Research Consortium 2, 3, or 5, regardless of diabetes status.
The study suggests that clopidogrel monotherapy might be considered instead of aspirin in patients who have undergone coronary stenting and completed dual antiplatelet therapy, regardless of diabetes status. The researchers noted that their study was limited by its post hoc design and lack of generalizability to populations with different ethnicities or baseline characteristics. Nevertheless, their findings have important implications for clinical practice in selecting optimal antiplatelet therapy for patients with and without diabetes who have undergone percutaneous coronary intervention.
Link to the article: https://jamanetwork.com/journals/jamacardiology/article-abstract/2803932
References Rhee, T.-M., Bae, J.-W., Park, K. W., Rha, S.-W., Kang, J., Lee, H., Yang, H.-M., Kwak, S.-H., Chae, I.-H., Shin, W.-Y., Kim, D.-K., Oh, J. H., Jeong, M. H., Kim, Y. H., Lee, N. H., Hur, S.-H., Yoon, J., Han, J.-K., Shin, E.-S., … Woo, S.-I. (2023). Aspirin vs clopidogrel for long-term maintenance after coronary stenting in patients with diabetes: A post hoc analysis of the host-exam trial. JAMA Cardiology. https://doi.org/10.1001/jamacardio.2023.0592
