SMart Angioplasty Research Team: CHoice of Optimal Anti-Thrombotic Strategy in Patients Undergoing Implantation of Coronary Drug-Eluting Stents 3
Summary
This study is a prospective, open-label, two-arm, randomized multicenter trial to compare the efficacy and safety of clopidogrel versus aspirin monotherapy beyond the standard duration of dual antiplatelet therapy (DAPT) (more than 12 months for myocardial infarction \[MI\] and more than 6 months for non-MI) after percutaneous coronary intervention (PCI) in patients at high risk of recurrent ischemic events.
Timeline
- Start
- 2020-08-10
- Primary completion
- 2024-10-31
- Completion
- 2024-11-12
Outcome
Met primary endpoint
paper 3-year incidence 4·4% [95% CI 3·4-5·4] vs 6·6% [5·4-7·8]; hazard ratio 0·71 [95% CI 0·54-0·93]; p=0·013 PMID 40174599 ↗
paper clopidogrel monotherapy, compared with aspirin monotherapy, significantly reduced the cumulative incidence of a composite of death from any cause, myocardial infarction, and stroke PMID 40174599 ↗
Publications
- Lee SY, Joo D, Lee JM, Park YH, Lee JY, Jeong JO, Kim CJ, Lee HC, Chang K, Park MW, Bae JW, Doh JH, Cho BR, Kim HY, Kim W, Kim U, Rha SW, Hong YJ, Lee HJ, Ahn SG, Kim DI, Cho JH, Her SH, Jeon DS, Han SH, Lee JB, Lee CW, Kang D, Choi KH, Park TK, Yang JH, Lee SY, Choi SH, Gwon HC, Song YB, Hahn JY, Yun KH; SMART-CHOICE 3 Investigators. Clopidogrel vs Aspirin According to Diabetes Mellitus: A Prespecified Analysis of the SMART-CHOICE 3 Trial. JACC Cardiovasc Interv. 2026 Jun 22:S1936-8798(26)01539-6. doi: 10.1016/j.jcin.2026.05.013. Online ahead of print.
- Choi KH, Park YH, Lee JY, Jeong JO, Kim CJ, Yun KH, Lee HC, Chang K, Park MW, Bae JW, Doh JH, Cho BR, Kim HY, Kim W, Kim U, Rha SW, Hong YJ, Lee HJ, Ahn SG, Kim DI, Cho JH, Her SH, Jeon DS, Han SH, Lee JB, Lee CW, Kang D, Lee JM, Park TK, Yang JH, Lee SY, Choi SH, Gwon HC, Song YB, Hahn JY; SMART-CHOICE 3 investigators. 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 Apr 12;405(10486):1252-1263. doi: 10.1016/S0140-6736(25)00449-0. Epub 2025 Mar 30.
Drugs
| Evaluation | Drug | Modality | Dose | Route |
|---|---|---|---|---|
| Comparator | Aspirin | Small molecule | 100 mg | Oral |
| Subject | Clopidogrel | Small molecule | 75 mg | Oral |