Indobufen-based Dual Antiplatelet Therapy in Patients with Multivessel Coronary Disease Undergoing Drug-eluting Stent Implantation Insight From the OPTION Trial

Lili Xu; Huajie Xu; Shujing Wu; Huanyi Zhang; Kang Cheng; Xiaoyan Wang; Manhua Chen; Guangping Li; Jiangnan Huang; Jun Lan; Guanghe Wei; Xin Zhao; Zhiyong Qi; Juying Qian; Hongyi Wu; Junbo Ge

doi:10.1016/j.ahj.2024.12.007

Indobufen-based Dual Antiplatelet Therapy in Patients with Multivessel Coronary Disease Undergoing Drug-eluting Stent Implantation Insight From the OPTION Trial

Am Heart J. 2024 Dec 20:S0002-8703(24)00335-1. doi: 10.1016/j.ahj.2024.12.007. Online ahead of print.

Authors

Lili Xu¹, Huajie Xu², Shujing Wu³, Huanyi Zhang⁴, Kang Cheng⁵, Xiaoyan Wang⁶, Manhua Chen⁷, Guangping Li⁸, Jiangnan Huang⁹, Jun Lan¹⁰, Guanghe Wei¹¹, Xin Zhao¹², Zhiyong Qi¹², Juying Qian¹³, Hongyi Wu¹⁴, Junbo Ge¹⁵

Affiliations

¹ Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, Shanghai, China; Department of Cardiology, Shanghai Geriatric Medical Center, Shanghai, China.
² Department of Infectious Diseases, Zhongshan Hospital, Fudan University, Shanghai, China.
³ Department of Cardiology, Zhongshan Hospital (Xiamen), Fudan University, Xiamen, Fujian, China.
⁴ Department of Cardiology, Taian City Central Hospital, Taian, Shandong, China.
⁵ Department of Cardiology, Xi'an No.3 Hospital, The Affiliated Hospital of Northwest University, Xi'an, Shanxi, China.
⁶ Department of Cardiology, Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu, China.
⁷ Department of Cardiology, The Central Hospital of Wuhan, Wuhan, Hubei, China.
⁸ Department of Cardiology, The Second Hospital of Tianjin Medical University, Tianjin, China.
⁹ Department of Cardiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China.
¹⁰ Department of Cardiology, Dongguan Third People's Hospital, Dongguan, Guangdong, China.
¹¹ Department of Cardiology, Affiliated Hospital of Jining Medical University, Jining, Shandong, China.
¹² Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, Shanghai, China.
¹³ Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, Shanghai, China. Electronic address: [email protected].
¹⁴ Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, Shanghai, China. Electronic address: [email protected].
¹⁵ Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, Shanghai, China; Department of Cardiology, Shanghai Geriatric Medical Center, Shanghai, China. Electronic address: [email protected].

PMID: 39710353
DOI: 10.1016/j.ahj.2024.12.007

Abstract

Background: It remains unclear whether indobufen-based dual antiplatelet therapy (DAPT) preserves ischemic protection while limiting bleeding risk in patients with multivessel coronary disease (MVD). This study aimed to investigate the efficacy and safety of indobufen-based DAPT in patients with MVD.

Methods: Patients in the OPTION trial were stratified based on the presence of MVD. We compared the ischemic and bleeding risks of indobufen-based DAPT (indobufen 100mg twice a day plus clopidogrel 75mg/d for 12 months) versus conventional DAPT (aspirin 100mg/d plus clopidogrel 75mg/d for 12 months) in patients with and without MVD, using landmarks at 6 months and 1 year post-percutaneous coronary intervention (PCI).

Results: Patients with MVD tended to be older and contained a higher prevalence of high-risk features. Compared with patients without MVD, those with MVD were at higher risk for net adverse clinical events and ischemic events. The risk of ischemic events between indobufen-based DAPT versus conventional DAPT was similar either in patients with MVD or without MVD during the first and second 6 months. During the first 6 months, indobufen-based DAPT decreased the risk of bleeding events consistently in patients with and without MVD. Of note, during the second 6 months, indobufen-based DAPT continually decreased the risk of bleeding events in patients with MVD but not in those without MVD.

Conclusions: In patients with MVD, indobufen plus clopidogrel DAPT compared to aspirin plus clopidogrel DAPT could reduce the risk of bleeding events while preserving ischemic protection during both the first and second 6 months post-PCI. Indobufen presents an effective option for patients with MVD, especially those at high ischemic risk requiring DAPT beyond 6 months post-PCI.

Trial registration: The trial was registered at www.chictr.org. A Randomized Controlled Trial of Indobufen versus Aspirin after Coronary Drug-eluting Stent Implantation: the OPTION Trial (ChiCTR-IIR-17013505).

Keywords: drug-eluting stent; dual antiplatelet therapy; indobufen; multivessel coronary disease.