Background

• Dual antiplatelet therapy is routinely used for one year after percutaneous coronary intervention (PCI) in patients considered at high risk of recurrent cardiovascular events.
• There remains uncertainty as to the optimal antiplatelet monotherapy beyond 12 months. Multiple studies have suggested that clopidogrel may provide more benefit than aspirin.
• This study evaluates registry data from Fuwei Hospital in China, comparing clopidogrel versus aspirin in a non-randomized manner from 12 to 36 months post-PCI in high-risk patients to assess clinical efficacy and bleeding complications.

Why is this study important?

This study confirms previously presented data from the same registry. In addition, it confirms data from prospective randomized clinical trials that revealed superior outcomes with clopidogrel compared with aspirin post-PCI in high-risk patients who have already completed 1 year of dual antiplatelet therapy, randomized to receive either clopidogrel or aspirin as antiplatelet monotherapy for an additional 3 years.

What did this study show?

7,392 high-risk consecutive patients post-PCI, who completed one year of dual antiplatelet therapy, were treated with either clopidogrel or aspirin monotherapy at the discretion of their physicians, in Fuwai Hospital in China. They were followed from 12 to 36 months.

The primary endpoint was net adverse clinical events, defined as the composite of all cause death, MI, stroke, or BARC type 2, 3, or 5 bleeding. The secondary endpoints were major adverse cardiac or cerebral events and major clinically relevant non-major bleeding, defined as type 2-3 or 5 BARC bleeding.

The results revealed statistically significant lower incidences of the primary endpoints and secondary endpoints. There was no difference in the rates of major or clinically relevant non major bleeding.

Therefore, this data study adds data suggesting that after completing dual antiplatelet therapy for one year post PCI in high-risk patients, clopidogrel has a benefit over aspirin in terms of clinical efficacy and has no increase in bleeding complications.