Association of Clinical Outcomes With Sex in Patients Receiving Chronic Maintenance Antiplatelet Monotherapy After Percutaneous Coronary Intervention: A Post Hoc Gender Analysis of the HOST‐EXAM Study
Background Clopidogrel monotherapy was more effective in reducing the risk of adverse clinical events than aspirin monotherapy in patients who underwent percutaneous coronary intervention (PCI) with drug‐eluting stent (DES), according to the HOST‐EXAM (Harmonizing Optimal Strategy for Treatment of C...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2023-04-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.122.026770 |
| _version_ | 1827796197076631552 |
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| author | Eun‐Seok Shin Eun Jung Jun Bitna Kim Ki‐Bum Won Bon‐Kwon Koo Jeehoon Kang Kyung Woo Park Tae‐Min Rhee Han‐Mo Yang Jung‐Kyu Han Hyo‐Soo Kim |
| author_facet | Eun‐Seok Shin Eun Jung Jun Bitna Kim Ki‐Bum Won Bon‐Kwon Koo Jeehoon Kang Kyung Woo Park Tae‐Min Rhee Han‐Mo Yang Jung‐Kyu Han Hyo‐Soo Kim |
| author_sort | Eun‐Seok Shin |
| collection | DOAJ |
| description | Background Clopidogrel monotherapy was more effective in reducing the risk of adverse clinical events than aspirin monotherapy in patients who underwent percutaneous coronary intervention (PCI) with drug‐eluting stent (DES), according to the HOST‐EXAM (Harmonizing Optimal Strategy for Treatment of Coronary Artery Stenosis–Extended Antiplatelet Monotherapy) trial. However, it remains unknown whether these effects differ based on sex. Methods and Results This was a prespecified secondary analysis of HOST‐EXAM in South Korea. Patients who maintained dual antiplatelet therapy without adverse clinical events for 6 to 18 months after PCI with DES were included. The primary end point was a composite of all‐cause mortality, nonfatal myocardial infarction, stroke, acute coronary syndrome, or Bleeding Academic Research Consortium (BARC) bleeding type ≥3 at 24 months after randomization. The bleeding end point was BARC types 2 to 5. The primary end point was comparable between the sexes (adjusted hazard ratio [HR], 0.79 [95% CI, 0.62–1.02]; P=0.067), and the bleeding end point (adjusted HR, 0.79 [95% CI, 0.54–1.17]; P=0.240) was also similar. Compared with aspirin, clopidogrel was associated with lower risk of primary composite end point (adjusted HR, 0.70 [95% CI, 0.55–0.89]; P=0.004) and bleeding end point (adjusted HR, 0.65 [95% CI, 0.44–0.96]; P=0.031) in men but not in women. Conclusions The primary composite end point and bleeding events were comparable between the sexes during chronic maintenance antiplatelet monotherapy after PCI with DES. Clopidogrel monotherapy, compared with aspirin, significantly reduced the risk of the primary composite end point and bleeding events in men. However, the beneficial effect of clopidogrel on the primary end point and bleeding events was mitigated in women. Registration Information clinicaltrials.gov. Identifier: NCT02044250. |
| first_indexed | 2024-03-11T19:01:58Z |
| format | Article |
| id | doaj.art-f964407fb3c74a79b5ea748b64919021 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-03-11T19:01:58Z |
| publishDate | 2023-04-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-f964407fb3c74a79b5ea748b649190212023-10-10T11:37:42ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802023-04-0112810.1161/JAHA.122.026770Association of Clinical Outcomes With Sex in Patients Receiving Chronic Maintenance Antiplatelet Monotherapy After Percutaneous Coronary Intervention: A Post Hoc Gender Analysis of the HOST‐EXAM StudyEun‐Seok Shin0Eun Jung Jun1Bitna Kim2Ki‐Bum Won3Bon‐Kwon Koo4Jeehoon Kang5Kyung Woo Park6Tae‐Min Rhee7Han‐Mo Yang8Jung‐Kyu Han9Hyo‐Soo Kim10Department of Cardiology Ulsan University Hospital University of Ulsan College of Medicine Ulsan South KoreaDepartment of Cardiology Ulsan University Hospital University of Ulsan College of Medicine Ulsan South KoreaDepartment of Cardiology Ulsan University Hospital University of Ulsan College of Medicine Ulsan South KoreaDepartment of Cardiology Ulsan University Hospital University of Ulsan College of Medicine Ulsan South KoreaDepartment of Internal Medicine, Cardiology Centre Seoul National University Hospital Seoul South KoreaDepartment of Internal Medicine, Cardiology Centre Seoul National University Hospital Seoul South KoreaDepartment of Internal Medicine, Cardiology Centre Seoul National University Hospital Seoul South KoreaDepartment of Internal Medicine, Cardiology Centre Seoul National University Hospital Seoul South KoreaDepartment of Internal Medicine, Cardiology Centre Seoul National University Hospital Seoul South KoreaDepartment of Internal Medicine, Cardiology Centre Seoul National University Hospital Seoul South KoreaDepartment of Internal Medicine, Cardiology Centre Seoul National University Hospital Seoul South KoreaBackground Clopidogrel monotherapy was more effective in reducing the risk of adverse clinical events than aspirin monotherapy in patients who underwent percutaneous coronary intervention (PCI) with drug‐eluting stent (DES), according to the HOST‐EXAM (Harmonizing Optimal Strategy for Treatment of Coronary Artery Stenosis–Extended Antiplatelet Monotherapy) trial. However, it remains unknown whether these effects differ based on sex. Methods and Results This was a prespecified secondary analysis of HOST‐EXAM in South Korea. Patients who maintained dual antiplatelet therapy without adverse clinical events for 6 to 18 months after PCI with DES were included. The primary end point was a composite of all‐cause mortality, nonfatal myocardial infarction, stroke, acute coronary syndrome, or Bleeding Academic Research Consortium (BARC) bleeding type ≥3 at 24 months after randomization. The bleeding end point was BARC types 2 to 5. The primary end point was comparable between the sexes (adjusted hazard ratio [HR], 0.79 [95% CI, 0.62–1.02]; P=0.067), and the bleeding end point (adjusted HR, 0.79 [95% CI, 0.54–1.17]; P=0.240) was also similar. Compared with aspirin, clopidogrel was associated with lower risk of primary composite end point (adjusted HR, 0.70 [95% CI, 0.55–0.89]; P=0.004) and bleeding end point (adjusted HR, 0.65 [95% CI, 0.44–0.96]; P=0.031) in men but not in women. Conclusions The primary composite end point and bleeding events were comparable between the sexes during chronic maintenance antiplatelet monotherapy after PCI with DES. Clopidogrel monotherapy, compared with aspirin, significantly reduced the risk of the primary composite end point and bleeding events in men. However, the beneficial effect of clopidogrel on the primary end point and bleeding events was mitigated in women. Registration Information clinicaltrials.gov. Identifier: NCT02044250.https://www.ahajournals.org/doi/10.1161/JAHA.122.026770aspirinclopidogreldrug‐eluting stentpercutaneous coronary interventionsexwomen |
| spellingShingle | Eun‐Seok Shin Eun Jung Jun Bitna Kim Ki‐Bum Won Bon‐Kwon Koo Jeehoon Kang Kyung Woo Park Tae‐Min Rhee Han‐Mo Yang Jung‐Kyu Han Hyo‐Soo Kim Association of Clinical Outcomes With Sex in Patients Receiving Chronic Maintenance Antiplatelet Monotherapy After Percutaneous Coronary Intervention: A Post Hoc Gender Analysis of the HOST‐EXAM Study Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease aspirin clopidogrel drug‐eluting stent percutaneous coronary intervention sex women |
| title | Association of Clinical Outcomes With Sex in Patients Receiving Chronic Maintenance Antiplatelet Monotherapy After Percutaneous Coronary Intervention: A Post Hoc Gender Analysis of the HOST‐EXAM Study |
| title_full | Association of Clinical Outcomes With Sex in Patients Receiving Chronic Maintenance Antiplatelet Monotherapy After Percutaneous Coronary Intervention: A Post Hoc Gender Analysis of the HOST‐EXAM Study |
| title_fullStr | Association of Clinical Outcomes With Sex in Patients Receiving Chronic Maintenance Antiplatelet Monotherapy After Percutaneous Coronary Intervention: A Post Hoc Gender Analysis of the HOST‐EXAM Study |
| title_full_unstemmed | Association of Clinical Outcomes With Sex in Patients Receiving Chronic Maintenance Antiplatelet Monotherapy After Percutaneous Coronary Intervention: A Post Hoc Gender Analysis of the HOST‐EXAM Study |
| title_short | Association of Clinical Outcomes With Sex in Patients Receiving Chronic Maintenance Antiplatelet Monotherapy After Percutaneous Coronary Intervention: A Post Hoc Gender Analysis of the HOST‐EXAM Study |
| title_sort | association of clinical outcomes with sex in patients receiving chronic maintenance antiplatelet monotherapy after percutaneous coronary intervention a post hoc gender analysis of the host exam study |
| topic | aspirin clopidogrel drug‐eluting stent percutaneous coronary intervention sex women |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.122.026770 |
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