Clopidogrel Versus Aspirin For Long-term Maintenance Monotherapy In Patients With High Ischemic Risk After PCI
ACCEL Lite: Featured ACCEL Interviews on Exciting CV Research
Release Date: 06/17/2025
Clopidogrel Versus Aspirin For Long-term Maintenance Monotherapy In Patients With High Ischemic Risk After PCI
ACCEL Lite: Featured ACCEL Interviews on Exciting CV Research
The SMART-CHOICE 3 trial demonstrated that clopidogrel monotherapy is more effective than aspirin monotherapy in reducing the risk of major adverse cardiac and cerebrovascular events in high-risk patients who completed standard dual antiplatelet therapy (DAPT) following percutaneous coronary intervention (PCI). Despite concerns that more potent antiplatelet agents may increase bleeding risk, the study found that clopidogrel significantly reduced ischemic events—including myocardial infarction and all-cause death—without increasing bleeding risk, making it a highly favorable option for...
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Dapagliflozin in Patients Undergoing Transcatheter Aortic Valve Implantation
ACCEL Lite: Featured ACCEL Interviews on Exciting CV Research
The DapaTAVI trial, conducted across 39 centers in Spain, is the first study to evaluate the use of sodium-glucose co-transporter-2 (SGLT-2) inhibitors, specifically dapagliflozin, in patients with heart failure undergoing transcatheter aortic valve implantation (TAVI). The trial found that patients who received dapagliflozin (10 mg daily) within 14 days of hospital discharge after TAVI experienced a 28% relative risk reduction in the composite outcome of all-cause mortality or worsening heart failure at one year, compared to those receiving standard care In this...
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PRAGUE-25 Trial: Catheter Ablation Versus Antiarrhythmic Drugs With Risk Factor Modification for Treatment of AF
ACCEL Lite: Featured ACCEL Interviews on Exciting CV Research
The PRAGUE-25 study evaluated the effectiveness of two treatment strategies in patients with both atrial fibrillation (AF) and obesity: catheter ablation versus lifestyle modification (including weight loss and increased physical activity) combined with antiarrhythmic drug therapy. While motivated patients who adhered to lifestyle changes experienced a reduction in AF episodes, the study found that catheter ablation was significantly more effective in achieving and maintaining sinus rhythm. In this episode, Drs. Joseph Marine and Pavel Osmancik discuss the trial’s...
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Lifetime Benefit by Control of Modifiable Risk Factors
ACCEL Lite: Featured ACCEL Interviews on Exciting CV Research
A Global Cardiovascular Risk Consortium study of nearly 2 million people worldwide found that avoiding five modifiable risk factors—hypertension, hyperlipidemia, abnormal weight, diabetes, and smoking—by age 50 added over a decade of life expectancy for both sexes. Midlife control of systolic blood pressure and smoking yielded the greatest global gains. In this interview, Drs. Roger S. Blumenthal and Christina Magnussen discuss how this landmark study moves beyond a predominantly North American and European focus, translating abstract risk factors into tangible years of healthy...
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ZENITH Phase 3 Trial: Sotatercept in Pulmonary Arterial Hypertension With High Mortality Risk
ACCEL Lite: Featured ACCEL Interviews on Exciting CV Research
The ZENITH trial evaluated sotatercept, an activin signaling inhibitor, in patients with advanced pulmonary arterial hypertension (PAH) at high risk of death. Sotatercept met its primary endpoint—time to first morbidity or mortality event—prompting an independent data monitoring committee to recommend early trial termination and offer the drug to all participants. In this interview, Drs. Allen J. Taylor and Marc Humbert discuss how ZENITH highlights sotatercept’s clinical benefit even in the sickest PAH patients, offering renewed hope for a disease long seen as...
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Cardiac Arrest During Long-Distance Running Races: 2010-2023
ACCEL Lite: Featured ACCEL Interviews on Exciting CV Research
The “Cardiac Arrest During Long-Distance Running Races: 2010–2023” study analyzed the incidence and outcomes of sudden cardiac arrests (SCAs) occurring during marathons and half-marathons in the United States. Known as the RACER2 study, it serves as a follow-up to the original RACER1 study, which covered the years 2000–2009. In this episode, Drs. Jonathan H. Kim and Aaron L. Baggish discussed the study findings, emphasizing the importance of continued vigilance and preparedness to further reduce the risk of fatal outcomes during endurance events. ...
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WARRIOR Trial: Outcomes to Reduce Events in Non-Obstructive Coronary Artery Disease
ACCEL Lite: Featured ACCEL Interviews on Exciting CV Research
Funded by the Congressionally Directed Medical Research Programs (CDMRP) of the Department of Defense, the WARRIOR (Women's IschemiA TRial to Reduce events In non-ObstRuctive CAD) Trial addresses the urgent need for evidence-based care in a growing population of patients—particularly women—experiencing ischemia without obstructive coronary artery disease (INOCA). This clinical strategy trial compares optimal medical therapy with usual care in women with angina but no significant coronary blockages. In this episode, Drs. Nanette Kass Wenger and Noel Bairey Merz discuss...
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STRIDE Trial: Effects of Semaglutide in Patients With Peripheral Artery Disease
ACCEL Lite: Featured ACCEL Interviews on Exciting CV Research
Patients with peripheral artery disease (PAD) often experience significant walking difficulties, and there are limited therapies available to improve their mobility. Investigation made through the STRIDE (Effects of Semaglutide on Functional Capacity in Patients With Type 2 Diabetes and Peripheral Arterial Disease) trial focused on semaglutide, a drug known for promoting weight loss, reducing inflammation, and lowering the risk of heart attack or stroke, to determine if it could enhance the functional abilities of PAD patients. In this interview, Drs. Alison Bailey and Marc...
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Evolut Low-Risk Trial: 5-year Data Outcomes
ACCEL Lite: Featured ACCEL Interviews on Exciting CV Research
Transcatheter aortic valve replacement (TAVR) has emerged as the preferred treatment for aortic stenosis. However, there is a lack of long-term outcome data for low-risk patients. The 5-year results from the Evolut Low-Risk randomized trial address this gap, offering compelling evidence with no significant negative signals regarding TAVR's clinical outcomes and valve performance. In this episode, Drs. Richard A. Chazal and Michael J. Reardon delve into the 5-year results from the Evolut Low-Risk randomized trial, offering valuable insights about the future of TAVR and its impact on...
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FRESH-UP Study: Liberal Fluid Intake Versus Fluid Restriction in Chronic Heart Failure
ACCEL Lite: Featured ACCEL Interviews on Exciting CV Research
Fluid restriction is often recommended for heart failure (HF) patients to prevent congestion, but its benefits and safety are unclear. The FRESH-UP study is the first to show that strict fluid restriction does not improve health status for chronic, symptomatic HF patients and may increase thirst distress without reducing mortality, hospitalization, acute kidney injury, or medication needs. In this interview, Roland RJ van Kimmenade, MD and Alison L. Bailey, MD, FACC discuss the impacts of the FRESH-UP study and how liberal fluid intake is safe for chronic HF patients, even enhancing...
info_outlineThe SMART-CHOICE 3 trial demonstrated that clopidogrel monotherapy is more effective than aspirin monotherapy in reducing the risk of major adverse cardiac and cerebrovascular events in high-risk patients who completed standard dual antiplatelet therapy (DAPT) following percutaneous coronary intervention (PCI). Despite concerns that more potent antiplatelet agents may increase bleeding risk, the study found that clopidogrel significantly reduced ischemic events—including myocardial infarction and all-cause death—without increasing bleeding risk, making it a highly favorable option for long-term maintenance therapy.
In this episode, Drs. Allen J. Taylor and Joo-Yong Hahn discuss the clinical implications of these findings and offer insights into selecting the optimal single antiplatelet regimen after PCI.
SUGGESTED MATERIALS
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Choi H, Park H, Lee JY, et al. Efficacy and safety of clopidogrel versus aspirin monotherapy in patients at high risk of subsequent cardiovascular event after percutaneous coronary intervention (SMART-CHOICE 3): a randomised, open-label, multicentre trial. Lancet. 2025;405(10486):1252-63. doi: 10.1016/S0140-6736(25)00449-0.
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Koo BK, Kang J, Park KW, et al.; HOST-EXAM investigators. Aspirin versus clopidogrel for chronic maintenance monotherapy after percutaneous coronary intervention (HOST-EXAM): an investigator-initiated, prospective, randomised, open-label, multicentre trial. Lancet. 2021;397(10293):2487-2496. doi: 10.1016/S0140-6736(21)01063-1.
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