Clopidogrel Better Than Aspirin for Long-Term Monotherapy After PCI, reports research

The median time between PCI and randomisation was 17·5 months (IQR 12·6–36·1 months). During a median follow-up period of 2·3 years (IQR 1·6–3·0), the primary endpoint occurred in 92 patients in the clopidogrel group and 128 patients in the aspirin group (Kaplan–Meier estimated 3-year incidence 4·4% [95% CI 3·4–5·4] vs 6·6% [5·4–7·8]; hazard ratio 0·71 [95% CI 0·54–0·93]; p=0·013). Death from any cause occurred in 50 patients in the clopidogrel group and 70 in the aspirin group (2·4% [1·6–3·1] vs 4·0% [2·9–5·0] at 3 years; 0·71 [0·49–1·02]); myocardial infarction in 23 patients in the clopidogrel group and 42 in the aspirin group (1·0% [0·6–1·4] vs 2·2% [1·4–2·9] at 3 years; 0·54 [0·33–0·90]); and stroke in 23 in the clopidogrel group and 29 in the aspirin group (1·3% [0·7–2·0] vs 1·3% [0·8–1·7] at 3 years; 0·79 [0·46–1·36]).

There was no difference in the risk of bleeding between the clopidogrel and aspirin groups (3·0% [2·0–3·9] vs 3·0% [2·2–3·9] at 3 years; 0·97 [0·67–1·42]). Clopidogrel was not associated with a higher incidence of any adverse event compared with aspirin. Among patients who were at high risk of recurrent ischaemic events and who completed the standard duration of DAPT following PCI, clopidogrel monotherapy, compared with aspirin monotherapy, significantly reduced the cumulative incidence of a composite of death from any cause, myocardial infarction, and stroke, without an apparent increase in the risk of bleeding.

Reference:

Efficacy and safety of clopidogrel versus aspirin monotherapy in patients at high risk of subsequent cardiovascular event after percutaneous coronary intervention (SMART-CHOICE 3): a randomised, open-label, multicentre trial. Choi, Ki Hong et al. The Lancet, Volume 0, Issue 0