The impact of body mass index (BMI) on antiplatelet monotherapy strategy for secondary prevention after percutaneous coronary intervention: A sub-study of the HOST-EXAM trial.
Minju Han, Jeehoon Kang, Bitna Kim, Doyeon Hwang, Han-Mo Yang, Kyung Woo Park, Ki-Bum Won, Jung-Kyu Han, Bon-Kwon Koo, Eun-Seok Shin, Hyo-Soo Kim
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引用次数: 0
Abstract
Background: Body mass index (BMI) may influence both clinical risk and pharmacologic response after percutaneous coronary intervention (PCI). We aimed to evaluate the association between BMI and long-term outcomes in a stabilized post-PCI population and to determine whether the effects of clopidogrel versus aspirin as single antiplatelet therapy (SAPT) differ across BMI strata.
Methods: This secondary analysis of the HOST-EXAM Extended study (median follow-up 5.8 years) included 4,549 per-protocol patients randomized to aspirin or clopidogrel after uneventful dual antiplatelet therapy. The primary endpoint was a composite of all-cause death, myocardial infarction, stroke, acute coronary syndrome readmission, or major bleeding (BARC ≥3). BMI was analyzed both categorically and continuously using multivariable Cox regression and restricted cubic spline models.
Results: There was a decreasing trend in adverse outcomes across increasing BMI categories (p for trend <0.001), although most differences were attenuated after adjustment. Clopidogrel was associated with a significantly lower risk of the primary endpoint compared to aspirin in overweight and obese patients (adjusted HRs: 0.51 for overweight, 0.69 for obese), with similar reductions for thrombotic events (HRs: 0.43 and 0.59, respectively). These findings were consistent in both categorical and spline-based analyses. No significant differences were observed between treatment groups for bleeding outcomes.
Conclusions: In stabilized post-PCI patients, clopidogrel was associated with improved long-term outcomes compared to aspirin in overweight and obese patients. Further studies are warranted to explore BMI-guided antiplatelet strategies.
Trial registration: This trial was registered at ClinicalTrials.gov (Registration number: NCT02044250). URL: https://clinicaltrials.gov/study/NCT02044250.
期刊介绍：
The American Heart Journal will consider for publication suitable articles on topics pertaining to the broad discipline of cardiovascular disease. Our goal is to provide the reader primary investigation, scholarly review, and opinion concerning the practice of cardiovascular medicine. We especially encourage submission of 3 types of reports that are not frequently seen in cardiovascular journals: negative clinical studies, reports on study designs, and studies involving the organization of medical care. The Journal does not accept individual case reports or original articles involving bench laboratory or animal research.
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