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KMID : 0368120200500020120
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Korean Circulation Journal
2020 Volume.50 No. 2 p.120 ~ p.129
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Clopidogrel versus Aspirin after Dual Antiplatelet Therapy in Acute Myocardial Infarction Patients Undergoing Drug-Eluting Stenting
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Sim Doo-Sun
Jeong Myung-Ho
Kim Hyo-Soo
Gwon Hyeon-Cheol
Seung Ki-Bae
Rha Seung-Woon
Chae Shung-Chull
Kim Chong-Jin
Cha Kwang-Soo
Park Jong-Seon
Yoon Jung-Han
Chae Jei-Keon
Joo Seung-Jae
Choi Dong-Ju
Hur Seung-Ho
Seong In-Whan
Cho Myeong-Chan
Kim Doo-Il
Oh Seok-Kyu
Ahn Tae-Hoon
Hwang Jin-Yong
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Abstract
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Background and Objectives: There is a paucity of data regarding the benefit of clopidogrel monotherapy after dual antiplatelet therapy (DAPT) in patients treated with drug-eluting stents (DES). This study compared outcome between clopidogrel versus aspirin as monotherapy after DES for acute myocardial infarction (MI).
Methods: From Korea Acute Myocardial Infarction Registry-National Institute of Health database, 1,819 patients treated with DES who were switched to monotherapy with clopidogrel (n=534) or aspirin (n=1,285) after uneventful 12-month DAPT were analyzed. The primary endpoint was net adverse clinical events (NACE), defined as a composite of death from any cause, MI, repeat percutaneous coronary intervention (PCI), stent thrombosis, ischemic stroke, or major bleeding during the period from 12 to 24 months.
Results: After adjustment using inverse probability of treatment weighting, patients who received clopidogrel, compared with those treated with aspirin, had a similar incidence of NACE (0.7% and 0.7%; hazard ratio, 1.06; 95% confidence interval, 0.31?3.60; p=0.923). The 2 groups had similar rates of death from any cause (0.1% in each group, p=0.789), MI (0.3% and 0.1%, respectively; p=0.226), repeat PCI (0.1% and 0.3%, respectively; p=0.548), stent thrombosis (0.1% and 0%, respectively; p=0.121), major bleeding (0.2% in each group, p=0.974), and major adverse cardiovascular and cerebrovascular events (0.5% in each group, p=0.924).
Conclusions: Monotherapy with clopidogrel, compared to aspirin, after DAPT showed similar clinical outcomes in patients with acute MI treated with DES.
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KEYWORD
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Antiplatelet agents, Drug-eluting stents, Myocardial infarction
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