Clopidogrel Vs Aspirin Monotherapy for Secondary Prevention After Percutaneous Coronary Intervention

Figures

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  Figure 1. Flowchart of the Study Population This flowchart summarizes the selection of the study cohort from a nationwide database. Among 591,646 patients with coronary artery disease who underwent percutaneous coronary intervention (PCI), those with continued dual antiplatelet therapy (DAPT), uncertain treatment exposure, events during DAPT, or insufficient data were excluded. The final cohort comprised 133,454 patients receiving single antiplatelet therapy (SAPT) with clopidogrel or aspirin and was followed through December 31, 2020.

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  Figure 2. Cumulative Risk of Effectiveness Outcomes After IPTW Cumulative incidence curves after stabilized inverse probability of treatment weighting (IPTW) are shown for major adverse cardiovascular events (MACE) (A), cardiovascular (CV) death (B), myocardial infarction (C), and ischemic stroke (D). Clopidogrel monotherapy was associated with a lower cumulative incidence than aspirin monotherapy across all outcomes. Red indicates aspirin, green indicates clopidogrel, and the shaded bands represent 95% CIs. ARD = absolute risk difference.

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  Figure 3. Cumulative Risk of Safety Outcomes After IPTW Cumulative incidence curves after stabilized IPTW are shown for total major bleeding (A) and major bleeding of gastrointestinal or intracranial origin (B). Clopidogrel monotherapy was associated with a lower bleeding risk than aspirin monotherapy. Red indicates aspirin, green indicates clopidogrel, and the shaded bands represent 95% CIs. Abbreviations as in Figure 2.

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  Figure 4. Subgroup Analysis of MACE Forest plot of HRs for MACEs across prespecified subgroups after stabilized inverse probability of treatment weighting. Clopidogrel monotherapy was associated with a lower risk than aspirin monotherapy, with no significant interaction across subgroups. Squares indicate HRs, horizontal lines indicate 95% CIs, and the dashed vertical line indicates the null value. ACS = acute coronary syndrome; CCS = chronic coronary syndrome; CKD = chronic kidney disease; DM = diabetes mellitus; PPI = proton pump inhibitor; other abbreviation as in Figure 2.

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  Figure 5. Cumulative Risk of Outcomes According to DAPT Duration Cumulative incidence curves for MACEs (A) and major bleeding (B) are shown according to abbreviated or standard DAPT duration. Clopidogrel monotherapy was associated with a lower risk of MACEs in both strata, whereas the reduction in major bleeding was more evident after standard DAPT duration. Abbreviations as in Figures 1 and 2.

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  Central Illustration. Monotherapy With Clopidogrel or Aspirin for Secondary Prevention Following Percutaneous Coronary Intervention Using the Korean National Health Claims Database (2009–2019), we identified 133,454 patients receiving chronic single antiplatelet therapy (SAPT) after percutaneous coronary intervention (PCI), including 67,652 on clopidogrel monotherapy and 65,802 on aspirin monotherapy. After stabilized inverse probability of treatment weighting, clopidogrel monotherapy was associated with lower cumulative incidence of major adverse cardiovascular events (MACEs) and major bleeding than aspirin monotherapy. These findings suggest that clopidogrel monotherapy may be preferred over aspirin for long-term secondary prevention during the stable period after PCI. ARD = absolute risk difference; CV = cardiovascular; DAPT = dual antiplatelet therapy.