{"markup":"\u003C?xml version=\u00221.0\u0022 encoding=\u0022UTF-8\u0022 ?\u003E\n    \u003Chtml version=\u0022HTML+RDFa+MathML 1.1\u0022\n    xmlns:content=\u0022http:\/\/purl.org\/rss\/1.0\/modules\/content\/\u0022\n    xmlns:dc=\u0022http:\/\/purl.org\/dc\/terms\/\u0022\n    xmlns:foaf=\u0022http:\/\/xmlns.com\/foaf\/0.1\/\u0022\n    xmlns:og=\u0022http:\/\/ogp.me\/ns#\u0022\n    xmlns:rdfs=\u0022http:\/\/www.w3.org\/2000\/01\/rdf-schema#\u0022\n    xmlns:sioc=\u0022http:\/\/rdfs.org\/sioc\/ns#\u0022\n    xmlns:sioct=\u0022http:\/\/rdfs.org\/sioc\/types#\u0022\n    xmlns:skos=\u0022http:\/\/www.w3.org\/2004\/02\/skos\/core#\u0022\n    xmlns:xsd=\u0022http:\/\/www.w3.org\/2001\/XMLSchema#\u0022\n    xmlns:mml=\u0022http:\/\/www.w3.org\/1998\/Math\/MathML\u0022\u003E\n  \u003Chead\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/js\/js_itu2PgFdrjV-docKmLK8Jn5oXe_05RgvQh73eOhI_mE.js\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_at_symbol.js?nznhip\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_article_reference_popup.js?nznhip\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/js\/js_I8yX6RYPZb7AtMcDUA3QKDZqVkvEn35ED11_1i7vVpc.js\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022\u003E\n\u003C!--\/\/--\u003E\u003C![CDATA[\/\/\u003E\u003C!--\n(function(i,s,o,g,r,a,m){i[\u0022GoogleAnalyticsObject\u0022]=r;i[r]=i[r]||function(){(i[r].q=i[r].q||[]).push(arguments)},i[r].l=1*new Date();a=s.createElement(o),m=s.getElementsByTagName(o)[0];a.async=1;a.src=g;m.parentNode.insertBefore(a,m)})(window,document,\u0022script\u0022,\u0022\/\/www.google-analytics.com\/analytics.js\u0022,\u0022ga\u0022);ga(\u0022create\u0022, \u0022UA-15605596-27\u0022, {\u0022cookieDomain\u0022:\u0022auto\u0022});ga(\u0022set\u0022, \u0022page\u0022, location.pathname + location.search + location.hash);ga(\u0022send\u0022, \u0022pageview\u0022);ga(\u0027create\u0027, \u0027UA-189672-26\u0027, \u0027auto\u0027, {\u0027name\u0027: \u0027hwTracker\u0027});\r\nga(\u0027hwTracker.send\u0027, \u0027pageview\u0027);\n\/\/--\u003E\u003C!]]\u003E\n\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022\u003E\n\u003C!--\/\/--\u003E\u003C![CDATA[\/\/\u003E\u003C!--\njQuery.extend(Drupal.settings, {\u0022basePath\u0022:\u0022\\\/\u0022,\u0022pathPrefix\u0022:\u0022\u0022,\u0022highwire\u0022:{\u0022markup\u0022:[{\u0022requested\u0022:\u0022full-text\u0022,\u0022variant\u0022:\u0022full-text\u0022,\u0022view\u0022:\u0022full\u0022,\u0022pisa\u0022:\u0022spmdc;12\\\/4\\\/19-b\u0022},{\u0022requested\u0022:\u0022long\u0022,\u0022variant\u0022:\u0022full-text\u0022,\u0022view\u0022:\u0022full\u0022,\u0022pisa\u0022:\u0022spmdc;12\\\/4\\\/19-b\u0022}],\u0022ac\u0022:{\u0022spmdc;12\\\/4\\\/19-b\u0022:{\u0022access\u0022:{\u0022reprint\u0022:true,\u0022full\u0022:true},\u0022pisa_id\u0022:\u0022spmdc;12\\\/4\\\/19-b\u0022,\u0022atom_uri\u0022:\u0022\u0022,\u0022jcode\u0022:\u0022spmdc\u0022}}},\u0022googleanalytics\u0022:{\u0022trackOutbound\u0022:1,\u0022trackMailto\u0022:1,\u0022trackDownload\u0022:1,\u0022trackDownloadExtensions\u0022:\u00227z|aac|arc|arj|asf|asx|avi|bin|csv|doc(x|m)?|dot(x|m)?|exe|flv|gif|gz|gzip|hqx|jar|jpe?g|js|mp(2|3|4|e?g)|mov(ie)?|msi|msp|pdf|phps|png|ppt(x|m)?|pot(x|m)?|pps(x|m)?|ppam|sld(x|m)?|thmx|qtm?|ra(m|r)?|sea|sit|tar|tgz|torrent|txt|wav|wma|wmv|wpd|xls(x|m|b)?|xlt(x|m)|xlam|xml|z|zip\u0022,\u0022trackUrlFragments\u0022:1},\u0022ajaxPageState\u0022:{\u0022js\u0022:{\u0022sites\\\/all\\\/libraries\\\/cluetip\\\/jquery.cluetip.js\u0022:1,\u0022sites\\\/all\\\/libraries\\\/cluetip\\\/lib\\\/jquery.hoverIntent.js\u0022:1,\u0022sites\\\/all\\\/libraries\\\/cluetip\\\/lib\\\/jquery.bgiframe.min.js\u0022:1,\u0022sites\\\/all\\\/modules\\\/highwire\\\/highwire\\\/plugins\\\/highwire_markup_process\\\/js\\\/highwire_at_symbol.js\u0022:1,\u0022sites\\\/all\\\/modules\\\/highwire\\\/highwire\\\/plugins\\\/highwire_markup_process\\\/js\\\/highwire_article_reference_popup.js\u0022:1,\u0022sites\\\/all\\\/modules\\\/contrib\\\/google_analytics\\\/googleanalytics.js\u0022:1,\u00220\u0022:1}}});\n\/\/--\u003E\u003C!]]\u003E\n\u003C\/script\u003E\n\u003Clink type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EThis article discusses results from a study that compared double- with triple-dose antiplatelet therapy (DAPT vs TAPT) in acute coronary syndrome patients who were undergoing percutaneous coronary intervention, which showed no difference in net clinical outcomes between the two treatment regimens after 1 month.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EMyocardial Infarction\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EInterventional Techniques \u0026amp; Devices Clinical Trials\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EHyo\u2013Soo Kim, MD, Seoul National University Hospital, Seoul, South Korea, reported results from a study that compared double\u2013 with triple\u2013dose antiplatelet therapy (DAPT vs TAPT) in acute coronary syndrome (ACS) patients who were undergoing percutaneous coronary intervention (PCI), which showed no difference in net clinical outcomes between the two treatment regimens after 1 month.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EThe Harmonizing Optimal Strategy for Treatment of Coronary Artery Stenosis \u2013 Safety \u0026amp; EffectiveneSS of Drug\u2013ElUting Stents \u0026amp; Antiplatelet Regimen [HOST\u2013ASSURE; \u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT01267734\u0026amp;atom=%2Fspmdc%2F12%2F4%2F19.2.atom\u0022\u003ENCT01267734\u003C\/a\u003E] trial was a 2 \u00d7 2 factorial design trial that compared the safety and long\u2013term effectiveness of coronary stenting, the everolimus\u2013eluting stenting system, and the zotarolimus\u2013eluting stenting system, as well as the short term efficacy and safety of TAPT, adding cilostazol to standard aspirin + clopidogrel dosing, versus DAPT with aspirin + higher\u2013dose clopidogrel. The presentation by Prof. Kim focused only on the results of the comparison of the two antiplatelet regimens.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EThe HOST\u2013ASSURE study comprised 3750 subjects who were undergoing PCI with drug\u2013eluting stents (DES) at 40 centers in South Korea. Subjects were randomized in a 1:1 fashion to either TAPT (aspirin 100 mg daily, clopidogrel 75 mg daily, cilostazol 200 mg loading\u2013dose followed by 100 mg twice daily) or DAPT (aspirin 100 mg daily, clopidogrel 150 mg daily). All patients were loaded with 300 mg of aspirin and 300 to 600 mg of clopidogrel prior to PCI. Patients with a left ventricular ejection fraction \u0026lt;25%, cardiogenic shock, or symptomatic heart failure were excluded from the study. The hypothesis that was being tested was that the net clinical outcome at 1 month with TAPT would be noninferior to that with DAPT. The net clinical outcome was defined as a composite of cardiac death, nonfatal myocardial infarction (periprocedural or spontaneous), definite or probable stent thrombosis, stroke, or PLATO major bleeding. The noninferiority margin was set at 0.75% absolute. In other words, the study had 90% power to show that the rate of the net clinical outcome in patients who were assigned TAPT was not more than 0.75% higher than with DAPT, assuming that no difference in rates between the regimens truly existed.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EPatients were well balanced between treatment assignments. The mean age was 63 years; one\u2013third of subjects were women, one\u2013third was diabetic, and one\u2013third of subjects were current smokers. Approximately 50% of patients presented with an acute coronary syndrome (unstable angina or non\u2013ST\u2013segment elevation myocardial infarction [NSTEMI]), and 10% presented with STEMI. Concomitant use of beta\u2013blockers (68%), statins (85%), and ACEI\/ARB (65%) was frequent.\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EThirty\u2013five days after randomization, 1.44% of DAPT and 1.22% of TAPT\u2013treated patients experienced the primary endpoint (ie, an absolute risk difference in favor of TAPT of 0.22%; p\u0026lt;0.001 for noninferiority; HR, 0.85; 95% CI, 0.49 to 1.48; p=0.57 for superiority). There were no significant differences between treatment groups when data were analyzed as individual risk components (all incidence rates were \u0026lt;1%), nor were there any differences in the rates of target lesion or vessel revascularization. Platelet reactivity (VerifyNow P2Y\u003Csub\u003E12\u003C\/sub\u003E Assay) was significantly (p\u0026lt;0.001) higher after clopidogrel loading and at the end of the study for patients who received the DAPT regimen.\u003C\/p\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003EScience Advisor\u0027s Note\u003C\/h2\u003E\n         \u003Cp id=\u0022p-7\u0022\u003EThis study has several limitations that are worthy of emphasizing. Comparing two treatment regimens for short\u2013term noninferiority of a net clinical benefit does not easily lend itself to a clinically meaningful conclusion. In addition, the comparator treatment arm in this trial was one of the regimens that were tested in OASIS\u20137, which was not significantly different from standard\u2013dose clopidogrel [\u003Cem\u003EMD Conference Express.\u003C\/em\u003E ESC Edition 2009]. Thus, it is not clear how the investigational TAPT maintenance regimen compares with standard\u2013dose DAPT post\u2013DES. Prof. Kim cautioned that the event rates were also lower than expected, which biases a noninferiority comparison toward concluding that no difference exists. Since the noninferiority margin (0.75% absolute) was \u0026gt;50% of the observed event rate in the comparator group (1.44%), even a 50% relative increase in the event rate with TAPT (to 2.16%) would not have crossed the noninferiority margin (2.19%). In addition, it is possible that higher\u2013than\u2013anticipated (and differential) nonadherence rates to allocated treatment (13.5% in the DAPT regimen vs 8.4% in the TAPT regimen) biased the results toward the null. Until larger and longer duration trials are conducted with standard comparator groups and primary efficacy outcomes, it remains unclear whether either regimen is effective or safe for routine clinical practice after DES implantation.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2012 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/12\/4\/19.2.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nznhip\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}