Frontiers in cardiovascular medicine · 2026
Long-term single antiplatelet therapy for patients with acute coronary syndrome at high-risk for ischemia and bleeding: a precision cohort study.
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Wanda Ma, Mengjie Lei, Jingyao Wang, Xue Sun, Xiao Wang, Cairong Li, Yachao Li, Zhigang Zhao, Zengming Xue
Аннотация
BACKGROUND: To compare the prognostic effects of different single antiplatelet therapy (SAPT) regimens (aspirin vs. clopidogrel) in patients with acute coronary syndrome (ACS) at high-risk for ischemia and bleeding following percutaneous coronary intervention (PCI) and switching from 12 months of dual antiplatelet therapy (DAPT) to SAPT.
METHODS: This study retrospectively analyzed 642 patients with ACS at high-risk of ischemia and bleeding who underwent PCI at a single-center between January 2017 and November 2022. After transitioning to SAPT, the cohort was divided into two groups based on the prescribed therapy: aspirin (n = 435) and clopidogrel (n = 207) groups. Patients were followed up for 24 months post-PCI. The primary endpoint was the occurrence of net adverse clinical events (NACE), including MACCE and major thrombolysis in myocardial infarction (TIMI) hemorrhage.
RESULTS: The incidence of NACE was comparable between the two patient groups. However, the clopidogrel group had a lower incidence of MACCE (4.3% vs. 9.2%, P = 0.031) and TVR (1.4% vs. 6.4%, P = 0.006) compared to the aspirin group. Cox regression analysis revealed that the incidence of MACCE and TVR in the clopidogrel group were 0.458 times [hazard ratio [HR]: 0.458; 95% confidence interval [CI]: 0.222-0.944; P = 0.034] and 0.220 times (HR: 0.220; 95% CI: 0.067-0.724; P = 0.013) that of the aspirin group, respectively.
CONCLUSION: In patients with ACS at high-risk, transitioning to clopidogrel as SAPT after 12 months of DAPT and successful PCI was associated with a reduced incidence of MACCE and TVR compared to aspirin, without an increased risk of major bleeding events.
METHODS: This study retrospectively analyzed 642 patients with ACS at high-risk of ischemia and bleeding who underwent PCI at a single-center between January 2017 and November 2022. After transitioning to SAPT, the cohort was divided into two groups based on the prescribed therapy: aspirin (n = 435) and clopidogrel (n = 207) groups. Patients were followed up for 24 months post-PCI. The primary endpoint was the occurrence of net adverse clinical events (NACE), including MACCE and major thrombolysis in myocardial infarction (TIMI) hemorrhage.
RESULTS: The incidence of NACE was comparable between the two patient groups. However, the clopidogrel group had a lower incidence of MACCE (4.3% vs. 9.2%, P = 0.031) and TVR (1.4% vs. 6.4%, P = 0.006) compared to the aspirin group. Cox regression analysis revealed that the incidence of MACCE and TVR in the clopidogrel group were 0.458 times [hazard ratio [HR]: 0.458; 95% confidence interval [CI]: 0.222-0.944; P = 0.034] and 0.220 times (HR: 0.220; 95% CI: 0.067-0.724; P = 0.013) that of the aspirin group, respectively.
CONCLUSION: In patients with ACS at high-risk, transitioning to clopidogrel as SAPT after 12 months of DAPT and successful PCI was associated with a reduced incidence of MACCE and TVR compared to aspirin, without an increased risk of major bleeding events.