Clopidogrel monotherapy versus aspirin monotherapy in females and males after percutaneous coronary intervention: a sex-stratified analysis of the SMART-CHOICE 3 trial.
EuroInterventionSep 21, 2026 (epub)
Clinical ResearchCardiology
Woochan Kwon, Ki Hong Choi, Yong Hwan Park et al.
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In 30 seconds
This study, a prespecified substudy of the SMART-CHOICE 3 trial, evaluated the effects of clopidogrel versus aspirin monotherapy in 5,506 patients post-percutaneous coronary intervention (PCI), including 1,002 females. Clopidogrel significantly reduced the primary endpoint of all-cause death, myocardial infarction, or stroke in females (4.3% vs 9.4%, adjusted HR 0.45, p=0.014), but not in males (4.4% vs 6.0%, adjusted HR 0.77, p=0.116).
Key findings
- Clopidogrel reduced the primary endpoint in females (4.3% vs 9.4%, adjusted HR 0.45, p=0.014).
- No significant difference in primary endpoint incidence between sexes (6.7% in females vs 5.2% in males, p=0.537).
- Clopidogrel did not significantly reduce the primary endpoint in males (4.4% vs 6.0%, adjusted HR 0.77, p=0.116).
- No significant interaction between sex and antiplatelet therapy was observed (p for interaction=0.288).
Why it matters
Understanding the differential effects of antiplatelet therapies based on sex can guide clinicians in personalizing treatment strategies for patients after PCI, potentially improving outcomes in high-risk populations.