Clopidogrel for Long-Term Therapy After PCI, Findings from 10-Year HOST-EXAM: ACC 2026 Update

HOST-EXAM trial, a landmark study recently released at the ACC 2026.

The trial sought to determine the effectiveness of Clopidogrel compared with Aspirin in preventing long-term complications in post PCI patients. The study enrolled over 5,400 patients in Korea who had remained event-free on dual antiplatelet therapy for 6-18 months after receiving a DES (drug-eluting stent). These patients were then randomly assigned in a 1:1 ratio to either the clopidogrel group or the aspirin group.

The 10-Year Findings

The primary endpoint of this follow-up included all-cause death, nonfatal MI, stroke, readmission for acute coronary syndrome, and major bleeding.

In the Intention-to-Treat analysis:

● Clopidogrel significantly reduced the relative risk of the primary composite endpoint by 14%, compared with the Aspirin group

● Crucially, Clopidogrel was associated with superiority in both thrombotic outcomes:18% relative risk reduction and any bleeding outcomes: 19% relative risk reduction.

● The Number Needed to Treat (NNT) to prevent one primary event improved from 51 at 2 years to 33 at 10 years, indicating that the clinical benefit of clopidogrel becomes more pronounced with longer follow-up.

In Per-Protocol analysis—those who adhered to their assigned medication—the benefits were even more pronounced. In this group, the NNT dropped to just 17, suggesting that consistent, long-term Clopidogrel use offers substantial protection.

Based on the 10 year follow-up research findings, the study indicates that for patients who have successfully navigated the first 6-18 months after a stent procedure, Clopidogrel monotherapy appears to be a safer and more effective option for long-term maintenance in post-PCI patients.