Physicians' Academy for Cardiovascular Education

Shorter DAPT with subsequent P2Y12 inhibitor monotherapy as safe and effective as 12 months DAPT after PCI

News - Mar. 19, 2019

One-Month Dual Antiplatelet Therapy Followed by Clopidogrel Monotherapy versus Standard 12-Month Dual Antiplatelet Therapy with Clopidogrel After Drug-Eluting Stent Implantation: STOPDAPT-2 trial

Presented at ACC.19 by Hirotoshi Watanabe (Kyoto University, Kyoto, Japan)


SMART-CHOICE: P2Y12 Inhibitor Monotherapy Versus Dual Antiplatelet Therapy in Patients Undergoing Implantation of Coronary Drug-eluting Stents

Presented at ACC.19 by Joo-Yong Hahn (Sungkyunkwan University School of Medicine, Seoul, South Korea)

Introduction and methods

There is uncertainty on the optimal duration of dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 inhibitor after coronary drug-eluting stent implantation with current generation stents. Short duration of DAPT and subsequent P2Y12 inhibitor monotherapy would be desirable to minimize bleeding events, if not associated with an increase in ischemic events.

In the STOPDAPT-2 trial, a multicenter, physician-initiated, open-label randomized controlled trial, the efficacy and safety of regimen of 1-month DAPT followed by clopidogrel monotherapy was tested in comparison to the standard regimen of 12-months DAPT with aspirin and clopidogrel after everolimus-eluting stents implantation. This was a non-inferiority trial with primary endpoint of net adverse CV events (NACE), a composite of CV death, MI, stroke, definite stent thrombosis, or TIMI major/minor bleeding, at 12 months. From December 2015 to December 2017, 3045 patients were enrolled and randomized in 1:1 ratio to the 2 groups.

The SMART-CHOICE was a prospective, multi-center, randomized, open-label, non-inferiority trial, in which 2993 patients after drug-eluting stent implantation (both everolimus and sirolimus) were assigned to 3 months DAPT followed by P2Y12 monotherapy (clopidogrel, ticagrelor or prasugrel) or at least 12 months DAPT. The primary endpoint was major adverse cardiac or cerebrovascular events (all-cause death, myocardial infarction, or stroke) at 12 months after the index procedure.

Main results




In both trials, shorter duration of DAPT (1 month in STOPDAPT-2 and 3 months in SMART-CHOICE) followed by P2Y12 inhibitor monotherapy was non-inferior to 12 months DAPT with respect to ischemic events in patients after drug-eluting stent implantation, and shorter duration of DAPT reduced bleeding.

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