Aspirin vs Clopidogrel for Long-term Maintenance After Coronary Stenting in Patients With Diabetes: A Post Hoc Analysis of the HOST-EXAM Trial
Authors' conclusion
In this study, clopidogrel monotherapy was associated with a lower rate of the primary composite end point compared to aspirin monotherapy as long-term maintenance therapy after dual antiplatelet therapy for coronary stenting in both patients with and without diabetes.
Study context
- Population
- Patients on DAPT without clinical events for 6 to 18 months after PCI with drug-eluting stents, with and without DM1,860 (34.2%) with DM
- Participants
- 5,438 patients
- Comparison
- Clopidogrel vs aspirin monotherapy, in patients with and without DM
- Primary endpoint
- Composite of:
- All-cause death
- Nonfatal MI
- Stroke
- Readmission for ACS
- Major bleeding (BARC type 3 or 5)
- Follow-up
- 24 months
Methodological detailsinvestigator-initiated, prospective, open-label, multicentre, 37 centres in Korea, subgroup analysis by diabetes, 5338 (98.2%) completed follow-up
- Investigator-initiated
- Prospective
- Open-label
- Multicentre
- 37 centres in Korea
- Subgroup analysis by diabetes
- 5338 (98.2%) completed follow-up
Primary result
As reported in the abstract
Primary composite end point, by DM status
Clopidogrel
- DM
- 6.3%
- No DM
- 5.3%
Aspirin
- DM
- 9.2%
- No DM
- 7.0%
DM
Clopidogrel6.3%
Aspirin9.2%
No DM
Clopidogrel5.3%
Aspirin7.0%
Clopidogrel vs AspirinHazard ratio (95% CI)P value
DM; ARD 2.7%; NNT 37
0.69(0.49–0.96)
P = 0.03No DM; ARD 1.6%; NNT 63
0.76(0.58–1.00)
P = 0.046Further findings
| Outcome | HR (95% CI) | |
|---|---|---|
| Thrombotic composite end point, by DM statusClopidogrel vs Aspirin · DM | 0.68 (0.45–1.04) | |
| Thrombotic composite end point, by DM statusClopidogrel vs Aspirin · no DM | 0.68 (0.49–0.93) | |
| 0.512Hazard ratio (log scale) |
- Thrombotic composite end point, by DM status: P for interaction = .99
Safety
| Outcome | HR (95% CI) | |
|---|---|---|
| Any bleeding (BARC 2, 3 or 5), by DM statusClopidogrel vs Aspirin · DM | 0.65 (0.39–1.09) | |
| Any bleeding (BARC 2, 3 or 5), by DM statusClopidogrel vs Aspirin · no DM | 0.74 (0.48–1.13) | |
| 0.20.5125Hazard ratio (log scale) |
- Any bleeding (BARC 2, 3 or 5), by DM status: P for interaction = .71
Original publication
Aspirin vs Clopidogrel for Long-term Maintenance After Coronary Stenting in Patients With Diabetes: A Post Hoc Analysis of the HOST-EXAM Trial. JAMA Cardiol. Published 1 June 2023. doi:10.
Summarised from the published abstract; every number is checked against it