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

Juwon Kim; Woo Jin Jang; Wang Soo Lee; Ki Hong Choi; Joo Myung Lee; Taek Kyu Park; Jeong Hoon Yang; Jin Ho Choi; Young Bin Song; Seung Hyuk Choi; Hyeon Cheol Gwon; Sang Hoon Lee; Ju Hyeon Oh; Woo Jung Chun; Yong Hwan Park; Eul Soon Im; Jin Ok Jeong; Byung Ryul Cho; Seok Kyu Oh; Kyeong Ho Yun; Deok Kyu Cho; Jong Young Lee; Young Youp Koh; Jang Whan Bae; Jae Woong Choi; Hyuck Jun Yoon; Seung Uk Lee; Jang Hyun Cho; Woong Gil Choi; Seung Woon Rha; Joo Yong Hahn

doi:10.1136/heartjnl-2020-318821

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

Juwon Kim, Woo Jin Jang, Wang Soo Lee, Ki Hong Choi, Joo Myung Lee, Taek Kyu Park, Jeong Hoon Yang, Jin Ho Choi, Young Bin Song, Seung Hyuk Choi, Hyeon Cheol Gwon, Sang Hoon Lee, Ju Hyeon Oh, Woo Jung Chun, Yong Hwan Park, Eul Soon Im, Jin Ok Jeong, Byung Ryul Cho, Seok Kyu Oh, Kyeong Ho YunDeok Kyu Cho, Jong Young Lee, Young Youp Koh, Jang Whan Bae, Jae Woong Choi, Hyuck Jun Yoon, Seung Uk Lee, Jang Hyun Cho, Woong Gil Choi, Seung Woon Rha, Joo Yong Hahn

Department of Biomedical Sciences

Research output: Contribution to journal › Article › peer-review

4 Citations (Scopus)

Abstract

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. Trial registration number NCT02079194.

Original language	English
Pages (from-to)	1077-1083
Number of pages	7
Journal	Heart
Volume	107
Issue number	13
DOIs	https://doi.org/10.1136/heartjnl-2020-318821
Publication status	Published - 2021 Jul 1

Keywords

clinical
coronary artery disease
percutaneous coronary intervention
pharmacology

ASJC Scopus subject areas

Cardiology and Cardiovascular Medicine

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10.1136/heartjnl-2020-318821

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Kim, J., Jang, W. J., Lee, W. S., Choi, K. H., Lee, J. M., Park, T. K., Yang, J. H., Choi, J. H., Song, Y. B., Choi, S. H., Gwon, H. C., Lee, S. H., Oh, J. H., Chun, W. J., Park, Y. H., Im, E. S., Jeong, J. O., Cho, B. R., Oh, S. K., ... Hahn, J. Y. (2021). P2Y12 inhibitor monotherapy after coronary stenting according to type of P2Y12 inhibitor. Heart, 107(13), 1077-1083. https://doi.org/10.1136/heartjnl-2020-318821

Kim, J, Jang, WJ, Lee, WS, Choi, KH, Lee, JM, Park, TK, Yang, JH, Choi, JH, Song, YB, Choi, SH, Gwon, HC, Lee, SH, Oh, JH, Chun, WJ, Park, YH, Im, ES, Jeong, JO, Cho, BR, Oh, SK, Yun, KH, Cho, DK, Lee, JY, Koh, YY, Bae, JW, Choi, JW, Yoon, HJ, Lee, SU, Cho, JH, Choi, WG, Rha, SW & Hahn, JY 2021, 'P2Y12 inhibitor monotherapy after coronary stenting according to type of P2Y12 inhibitor', Heart, vol. 107, no. 13, pp. 1077-1083. https://doi.org/10.1136/heartjnl-2020-318821

@article{b3934d39fa2a4f8c8d04099cd30200e5,

title = "P2Y12 inhibitor monotherapy after coronary stenting according to type of P2Y12 inhibitor",

abstract = "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. Trial registration number NCT02079194.",

keywords = "clinical, coronary artery disease, percutaneous coronary intervention, pharmacology",

author = "Juwon Kim and Jang, {Woo Jin} and Lee, {Wang Soo} and Choi, {Ki Hong} and Lee, {Joo Myung} and Park, {Taek Kyu} and Yang, {Jeong Hoon} and Choi, {Jin Ho} and Song, {Young Bin} and Choi, {Seung Hyuk} and Gwon, {Hyeon Cheol} and Lee, {Sang Hoon} and Oh, {Ju Hyeon} and Chun, {Woo Jung} and Park, {Yong Hwan} and Im, {Eul Soon} and Jeong, {Jin Ok} and Cho, {Byung Ryul} and Oh, {Seok Kyu} and Yun, {Kyeong Ho} and Cho, {Deok Kyu} and Lee, {Jong Young} and Koh, {Young Youp} and Bae, {Jang Whan} and Choi, {Jae Woong} and Yoon, {Hyuck Jun} and Lee, {Seung Uk} and Cho, {Jang Hyun} and Choi, {Woong Gil} and Rha, {Seung Woon} and Hahn, {Joo Yong}",

note = "Funding Information: Competing interests J-YH reports receiving grants from Abbott Vascular, Boston Scientific, Biotronik, Korean Society of Interventional Cardiology, and Medtronic; and speaker{\textquoteright}s fees from AstraZeneca, Daiichi Sankyo and Sanofi-Aventis. H-CG reports receiving research grants from Abbott Vascular, Boston Scientific and Medtronic; and speaker{\textquoteright}s fees from Abbott Vascular, Boston Scientific and Medtronic. All other authors declare that they have no conflicts of interest. Funding Information: Funding This study was supported by grants from the Korean Society of Interventional Cardiology (grant 2013-3), Abbott Vascular, Biotronik, Boston Scientific and the Korea Health Technology R&D Project through the Korea Health Industry Development Institute funded by the Ministry of Health & Welfare, Republic of Korea (grant number: HI10C2020). Funding Information: Disclaimer J-YH reports receiving grants from Abbott Vascular, Boston Scientific, Biotronik, Korean Society of Interventional Cardiology, and Medtronic; and speaker{\textquoteright}s fees from AstraZeneca, Daiichi Sankyo, and sanofi-aventis. H-CG reports receiving research grants from Abbott Vascular, Boston Scientific, and Medtronic; and speaker{\textquoteright}s fees from Abbott Vascular, Boston Scientific, and Medtronic. Publisher Copyright: {\textcopyright} ",

year = "2021",

month = jul,

day = "1",

doi = "10.1136/heartjnl-2020-318821",

language = "English",

volume = "107",

pages = "1077--1083",

journal = "Heart",

issn = "1355-6037",

publisher = "BMJ Publishing Group",

number = "13",

}

TY - JOUR

T1 - P2Y12 inhibitor monotherapy after coronary stenting according to type of P2Y12 inhibitor

AU - Kim, Juwon

AU - Jang, Woo Jin

AU - Lee, Wang Soo

AU - Choi, Ki Hong

AU - Lee, Joo Myung

AU - Park, Taek Kyu

AU - Yang, Jeong Hoon

AU - Choi, Jin Ho

AU - Song, Young Bin

AU - Choi, Seung Hyuk

AU - Gwon, Hyeon Cheol

AU - Lee, Sang Hoon

AU - Oh, Ju Hyeon

AU - Chun, Woo Jung

AU - Park, Yong Hwan

AU - Im, Eul Soon

AU - Jeong, Jin Ok

AU - Cho, Byung Ryul

AU - Oh, Seok Kyu

AU - Yun, Kyeong Ho

AU - Cho, Deok Kyu

AU - Lee, Jong Young

AU - Koh, Young Youp

AU - Bae, Jang Whan

AU - Choi, Jae Woong

AU - Yoon, Hyuck Jun

AU - Lee, Seung Uk

AU - Cho, Jang Hyun

AU - Choi, Woong Gil

AU - Rha, Seung Woon

AU - Hahn, Joo Yong

N1 - Funding Information: Competing interests J-YH reports receiving grants from Abbott Vascular, Boston Scientific, Biotronik, Korean Society of Interventional Cardiology, and Medtronic; and speaker’s fees from AstraZeneca, Daiichi Sankyo and Sanofi-Aventis. H-CG reports receiving research grants from Abbott Vascular, Boston Scientific and Medtronic; and speaker’s fees from Abbott Vascular, Boston Scientific and Medtronic. All other authors declare that they have no conflicts of interest. Funding Information: Funding This study was supported by grants from the Korean Society of Interventional Cardiology (grant 2013-3), Abbott Vascular, Biotronik, Boston Scientific and the Korea Health Technology R&D Project through the Korea Health Industry Development Institute funded by the Ministry of Health & Welfare, Republic of Korea (grant number: HI10C2020). Funding Information: Disclaimer J-YH reports receiving grants from Abbott Vascular, Boston Scientific, Biotronik, Korean Society of Interventional Cardiology, and Medtronic; and speaker’s fees from AstraZeneca, Daiichi Sankyo, and sanofi-aventis. H-CG reports receiving research grants from Abbott Vascular, Boston Scientific, and Medtronic; and speaker’s fees from Abbott Vascular, Boston Scientific, and Medtronic. Publisher Copyright: ©

PY - 2021/7/1

Y1 - 2021/7/1

N2 - 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. Trial registration number NCT02079194.

AB - 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. Trial registration number NCT02079194.

KW - clinical

KW - coronary artery disease

KW - percutaneous coronary intervention

KW - pharmacology

UR - http://www.scopus.com/inward/record.url?scp=85103194847&partnerID=8YFLogxK

U2 - 10.1136/heartjnl-2020-318821

DO - 10.1136/heartjnl-2020-318821

M3 - Article

C2 - 33758008

AN - SCOPUS:85103194847

SN - 1355-6037

VL - 107

SP - 1077

EP - 1083

JO - Heart

JF - Heart

IS - 13

ER -

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

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