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The Association of CHADS-P2A2RC Risk Score With Clinical Outcomes in Patients Taking P2Y12 Inhibitor Monotherapy After 3 Months of Dual Antiplatelet Therapy Following Percutaneous Coronary Intervention

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Author(s)
Pil Sang SongSeok-Woo SeongJi-Yeon KimSoo Yeon AnMi Joo KimKye Taek AhnSeon-Ah JinJin-Ok JeongJeong Hoon YangJoo-Yong HahnHyeon-Cheol GwonWoo Jin JangHyuck Jun YoonJang-Whan BaeWoong Gil ChoiYoung Bin Song
Keimyung Author(s)
Yoon, Hyuck Jun
Department
Dept. of Internal Medicine (내과학)
Journal Title
Korean Circ J
Issued Date
2024
Volume
54
Issue
4
Keyword
Coronary artery diseaseAngioplastyDual Anti-Platelet TherapyPrognosis
Abstract
Background and Objectives:
Concerns remain that early aspirin cessation may be associated with potential harm in subsets at high risk of ischemic events. This study aimed to assess the effects of P2Y12 inhibitor monotherapy after 3-month dual antiplatelet therapy (DAPT) vs. prolonged DAPT (12-month or longer) based on the ischemic risk stratification, the CHADS-P2A2RC, after percutaneous coronary intervention (PCI).

Methods:
This was a sub-study of the SMART-CHOICE trial. The effect of the randomized antiplatelet strategies was assessed across 3 CHADS-P2A2RC risk score categories. The primary outcome was a major adverse cardiac and cerebral event (MACCE), a composite of all-cause death, myocardial infarction, or stroke.

Results:
Up to 3 years, the high CHADS-P2A2RC risk score group had the highest incidence of MACCE (105 [12.1%], adjusted hazard ratio [HR], 2.927; 95% confidence interval [CI], 1.358–6.309; p=0.006) followed by moderate-risk (40 [1.4%], adjusted HR, 1.786; 95% CI, 0.868–3.674; p=0.115) and low-risk (9 [0.5%], reference). In secondary analyses, P2Y12 inhibitor monotherapy reduced the Bleeding Academic Research Consortium (BARC) types 2, 3, or 5 bleeding without increasing the risk of MACCE as compared with prolonged DAPT across the 3 CHADS-P2A2RC risk strata without significant interaction term (interaction p for MACCE=0.705 and interaction p for BARC types 2, 3, or 5 bleeding=0.055).

Conclusions:
The CHADS-P2A2RC risk score is valuable in discriminating high-ischemic-risk patients. Even in such patients with a high risk of ischemic events, P2Y12 inhibitor monotherapy was associated with a lower incidence of bleeding without increased risk of ischemic events compared with prolonged DAPT.
Keimyung Author(s)(Kor)
윤혁준
Publisher
School of Medicine (의과대학)
Type
Article
ISSN
1738-5555
Source
https://e-kcj.org/search.php?where=aview&id=10.4070/kcj.2023.0268&code=0054KCJ&vmode=FULL
DOI
10.4070/kcj.2023.0268
URI
https://kumel.medlib.dsmc.or.kr/handle/2015.oak/45383
Appears in Collections:
1. School of Medicine (의과대학) > Dept. of Internal Medicine (내과학)
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