The article discusses the importance of selecting the optimal antiplatelet agent in patients who have undergone percutaneous coronary intervention (PCI), particularly in those with diabetes. The study aims to investigate cardiovascular outcomes with clopidogrel versus aspirin in patients with and without diabetes.
The study is a post hoc analysis of the HOST-EXAM randomized clinical trial, which enrolled patients who received dual antiplatelet therapy without clinical events for 6 to 18 months after PCI with drug-eluting stents. The enrolled patients were randomized 1:1 to receive clopidogrel or aspirin monotherapy. Subgroup analyses were performed by the presence of diabetes. The main outcome was the primary composite endpoint of all-cause death, nonfatal myocardial infarction, stroke, readmission due to acute coronary syndrome, and major bleeding at 24-month follow-up.
Of the 5438 patients included in the analysis, 1860 had diabetes. 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%) and without diabetes (5.3% vs 7.0%). The presence of diabetes was not associated with a difference in benefit observed with clopidogrel monotherapy over aspirin for the thrombotic composite endpoint and any bleeding with Bleeding Academic Research Consortium 2, 3, or 5.
In conclusion, the study suggests that clopidogrel monotherapy may be considered instead of aspirin in patients who have undergone coronary stenting and successfully completed dual antiplatelet therapy, regardless of diabetes status. This finding is significant as it addresses the lack of studies on the efficacy and safety of clopidogrel versus aspirin for long-term maintenance after PCI in patients with diabetes.
doi:10.1001/jamacardio.2023.0592
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