SMART-CHOICE Data Show That Stopping Aspirin 3 Months After Stenting Does Not Increase Mortality Risk

March 26, 2019—The American College of Cardiology (ACC) announced the presentation of data from the SMART-CHOICE trial that suggest patients who stopped taking aspirin 3 months after stenting and continued taking a P2Y12 inhibitor did not experience higher mortality rates compared to those who received standard dual antiplatelet therapy (DAPT). The data were presented at the ACC's 68th Annual Scientific Session, held March 16–18 in New Orleans, Louisiana.

As summarized by the ACC, the SMART-CHOICE trial enrolled 2,993 patients at 33 medical centers in South Korea. The study participants, who underwent percutaneous coronary intervention and implantation of a drug-eluting stent, were randomized to one of two medication therapies: (1) standard DAPT for 1 year, or (2) aspirin and a P2Y12 inhibitor for 3 months, followed by only a P2Y12 inhibitor for the remaining 9 months. The primary endpoint was a composite of death from any cause, heart attack, or stroke.

At 1 year, 2.9% of those who stopped aspirin experienced the primary endpoint compared to 2.5% in the standard DAPT arm. In addition, 2% of those who stopped aspirin experienced major bleeding, compared to 3.4% among those who received standard DAPT. The net rate of adverse clinical events was not significantly different between the two groups, according to the ACC announcement.

The trial’s inclusion of different P2Y12 inhibitors (clopidogrel, prasugrel, ticagrelor) distinguishes it from other trials investigating DAPT alternatives, commented Joo-Yong Hahn, MD, Professor of Medicine at Sungkyunkwan University School of Medicine in Seoul, South Korea, and the study’s lead author.

In the ACC announcement, it was reported that a proportion of patients in the group assigned to stop aspirin did receive aspirin after 3 months; however, detailed analysis suggested this does not undermine the overall findings.

The ACC announcement also noted that further analysis of the data will be performed to determine the effect that the type of P2Y12 inhibitor used and the patients’ physiological responses to the P2Y12 inhibitor, as well as whether risk of ischemic events was varied among patients with acute coronary syndrome versus stable ischemic heart disease.