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Clopidogrel bests aspirin for long-term maintenance after PCI: Analysis of HOST-EXAM Trial
![Clopidogrel bests aspirin for long-term maintenance after PCI: Analysis of HOST-EXAM Trial Clopidogrel bests aspirin for long-term maintenance after PCI: Analysis of HOST-EXAM Trial](https://medicaldialogues.in/h-upload/2023/04/13/750x450_207374-antiplatelet-therapy.webp)
Korea: A post hoc analysis of the HOST-EXAM trial has suggested using clopidogrel over aspirin monotherapy, irrespective of diabetes presence, in patients who have undergone coronary stenting and completed dual antiplatelet therapy (DAPT).
The study, published in JAMA Cardiology, showed that clopidogrel monotherapy was linked with a lower rate of adverse events compared to aspirin monotherapy as long-term maintenance therapy after dual antiplatelet therapy for coronary stenting among people with and without diabetes.
Selection of the optimal antiplatelet agent in patients who have received PCI (percutaneous coronary intervention) is crucial in those with diabetes due to an elevated risk of ischemic events in these patients. Moreover, there is a lack of studies on the safety and efficacy of clopidogrel vs aspirin for long-term maintenance after PCI in people with diabetes.
To fill this knowledge gap, Tae-Min Rhee, Seoul National University College of Medicine, Seoul, Korea, and colleagues aimed to investigate cardiovascular outcomes with clopidogrel versus aspirin in patients with and without diabetes.
The researchers performed a post hoc analysis of the HOST-EXAM randomized clinical trial, a prospective, investigator-initiated, randomized, multicenter, and open-label trial conducted in Korea's 37 centres. They enrolled patients who received DAPT without clinical events for 6 to 18 months after PCI with drug-eluting stents and were followed at 6, 12, 18, and 24 months. All 5438 patients in the original trial were included in the analysis conducted from June to October 2021.
Enrolled patients were randomized in the ratio of 1:1 to clopidogrel or aspirin monotherapy. Subgroup analyses were performed by the presence or absence of diabetes.
The study's primary outcome was the composite endpoint of nonfatal myocardial infarction, all-cause death, stroke, major bleeding, and readmissions due to acute coronary syndrome at the follow-up of 24 months.
The authors reported the following findings:
- Of 5438 patients (mean age, 63.5 years; 25.5% female), 34.2% had diabetes (925 in the clopidogrel arm and 935 in the aspirin arm), and 98.2% completed follow-up.
- The rate of the primary composite endpoint was significantly lower in the clopidogrel group compared to the aspirin group in patients with diabetes (6.3% vs 9.2%; hazard ratio [HR], 0.69; absolute risk difference [ARD], 2.7%; number needed to treat [NNT], 37) and without diabetes (5.3% vs 7.0%; HR, 0.76; ARD, 1.6%, NNT, 63).
- The presence of diabetes was not associated with a difference in benefit observed with clopidogrel monotherapy over aspirin for the thrombotic composite endpoint (HR, 0.68 for patients with diabetes vs HR, 0.68) and any bleeding with Bleeding Academic Research Consortium 2, 3, or 5 (HR, 0.65 for patients with diabetes vs HR, 0.74).
"Clopidogrel could be considered over aspirin monotherapy irrespective of diabetes in patients who have undergone coronary stenting and completed dual antiplatelet therapy," the researchers concluded.
Reference:
Rhee T, Bae J, Park KW, et al. Aspirin vs Clopidogrel for Long-term Maintenance After Coronary Stenting in Patients With Diabetes: A Post Hoc Analysis of the HOST-EXAM Trial. JAMA Cardiol. Published online April 12, 2023. doi:10.1001/jamacardio.2023.0592
MSc. Biotechnology
Medha Baranwal joined Medical Dialogues as an Editor in 2018 for Speciality Medical Dialogues. She covers several medical specialties including Cardiac Sciences, Dentistry, Diabetes and Endo, Diagnostics, ENT, Gastroenterology, Neurosciences, and Radiology. She has completed her Bachelors in Biomedical Sciences from DU and then pursued Masters in Biotechnology from Amity University. She has a working experience of 5 years in the field of medical research writing, scientific writing, content writing, and content management. She can be contacted at  editorial@medicaldialogues.in. Contact no. 011-43720751
Dr Kamal Kant Kohli-MBBS, DTCD- a chest specialist with more than 30 years of practice and a flair for writing clinical articles, Dr Kamal Kant Kohli joined Medical Dialogues as a Chief Editor of Medical News. Besides writing articles, as an editor, he proofreads and verifies all the medical content published on Medical Dialogues including those coming from journals, studies,medical conferences,guidelines etc. Email: editorial@medicaldialogues.in. Contact no. 011-43720751