Clopidogrel monotherapy versus aspirin monotherapy in females and males after percutaneous coronary intervention: a sex-stratified analysis of the SMART-CHOICE 3 trial
Authors' conclusion
In patients with remote PCI and a high risk of recurrent ischaemic events, clopidogrel monotherapy showed a directionally consistent reduction in the composite endpoint of all-cause death, myocardial infarction, or stroke compared with aspirin in both females and males. No significant sex-by-treatment interaction was observed, supporting the consistency of the treatment effect across sexes.
Study context
- Population
- Patients at high risk of recurrent ischaemic events who had completed the standard duration of dual antiplatelet therapy after percutaneous coronary intervention (PCI), South Koreapatients enrolled · females 1,002 · males 4,504
- Participants
- 5,506 patients
- Comparison
- Clopidogrel, compared with aspirin, in females and males
- Primary endpoint
- Composite of:
- All-cause death
- Myocardial infarction
- Stroke
Methodological detailsrandomly assigned
- Randomly assigned
Primary result
As reported in the abstract
Estimate (95% CI)P value
Clopidogrelvs Aspirinfemales: 4.3% vs 9.4%
adjusted HR 0.45(0.24–0.85)
P = 0.014Clopidogrelvs Aspirinmales: 4.4% vs 6.0%
adjusted HR 0.77(0.56–1.07)
P = 0.116Femalesvs malesincidence by sex: 6.7% vs 5.2%
adjusted hazard ratio 0.89(0.62–1.28)
P = 0.537Further findings
Baseline risk profile by sex
- Females had a higher risk profile than males
Original publication
Clopidogrel monotherapy versus aspirin monotherapy in females and males after percutaneous coronary intervention: a sex-stratified analysis of the SMART-CHOICE 3 trial. EuroIntervention. Published 21 September 2026. doi:10.
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