Article Impact Level: HIGH Data Quality: STRONG Summary of Journal of the American College of Cardiology, 83(1), 17–31. https://doi.org/10.1016/j.jacc.2023.10.013 Dr. Hirotoshi Watanabe et al.
Points
- STOPDAPT-2 trial compared clopidogrel monotherapy after one month of DAPT with aspirin monotherapy after 12 months of DAPT post-PCI over five years.
- The clopidogrel group was non-inferior but not superior to the aspirin group for the primary endpoint (composite of cardiovascular outcomes or major bleeding).
- Clopidogrel was superior for cardiovascular outcomes but not for major bleeding compared to aspirin.
- A one-year landmark analysis showed that clopidogrel was numerically superior to aspirin for cardiovascular events without a significant difference in major bleeding.
- Findings suggest that clopidogrel may be an attractive alternative to aspirin with a borderline ischemic benefit beyond one year after PCI.
Summary
The study aimed to compare the long-term efficacy and safety of clopidogrel monotherapy following one month of dual antiplatelet therapy (DAPT) with aspirin monotherapy following 12 months of DAPT after percutaneous coronary intervention (PCI) over five years. The STOPDAPT-2 trial, a multicenter, open-label, adjudicator-blinded, randomized clinical trial conducted in Japan, involved patients who underwent PCI with cobalt-chromium everolimus-eluting stents. The primary endpoint was a composite of cardiovascular outcomes or significant bleeding.
The results from the study, which included 3,005 patients, demonstrated that the clopidogrel group was non-inferior but not superior to the aspirin group for the primary endpoint. However, it was found to be superior for cardiovascular outcomes and not superior for significant bleeding. The 1-year landmark analysis also indicated that clopidogrel was numerically, but not significantly, superior to aspirin for cardiovascular events without a significant difference in major bleeding. These findings suggest that clopidogrel may present an attractive alternative to aspirin with a borderline ischemic benefit beyond one year after PCI.
In conclusion, the STOPDAPT-2 trial provided valuable insights into the long-term use of clopidogrel and aspirin monotherapy following DAPT after PCI. The study’s findings support the potential of clopidogrel as a viable alternative to aspirin, particularly in terms of cardiovascular outcomes, highlighting its potential benefit in the post-PCI setting.
Link to the article: https://www.sciencedirect.com/science/article/abs/pii/S0735109723077501
References Watanabe, H., Morimoto, T., Natsuaki, M., Yamamoto, K., Obayashi, Y., Nishikawa, R., Ando, K., Ono, K., Kadota, K., Suwa, S., Morishima, I., Yoshida, R., Hata, Y., Akao, M., Yagi, M., Suematsu, N., Morino, Y., Yokomatsu, T., Takamisawa, I., … Kimura, T. (2024). Clopidogrel vs Aspirin Monotherapy Beyond 1 Year After Percutaneous Coronary Intervention. Journal of the American College of Cardiology, 83(1), 17–31. https://doi.org/10.1016/j.jacc.2023.10.013
