Han Minju, Kang Jeehoon, Kim Bitna, Hwang Doyeon, Yang Han-Mo, Park Kyung Woo, Won Ki-Bum, Han Jung-Kyu, Koo Bon-Kwon, Shin Eun-Seok, Kim Hyo-Soo
Division of Cardiology, Seoul National University Hospital, Seoul, South Korea.
Division of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea.
Am Heart J. 2025 Dec;290:258-267. doi: 10.1016/j.ahj.2025.07.005. Epub 2025 Jul 5.
Body mass index (BMI) may influence both clinical risk and pharmacologic response after percutaneous coronary intervention (PCI). We aimed to evaluate the association between BMI and long-term outcomes in a stabilized post-PCI population and to determine whether the effects of clopidogrel versus aspirin as single antiplatelet therapy (SAPT) differ across BMI strata.
This secondary analysis of the HOST-EXAM Extended study (median follow-up 5.8 years) included 4,549 per-protocol patients randomized to aspirin or clopidogrel after uneventful dual antiplatelet therapy. The primary endpoint was a composite of all-cause death, myocardial infarction, stroke, acute coronary syndrome readmission, or major bleeding (BARC ≥3). BMI was analyzed both categorically and continuously using multivariable Cox regression and restricted cubic spline models.
There was a decreasing trend in adverse outcomes across increasing BMI categories (p for trend < .001), although most differences were attenuated after adjustment. Clopidogrel was associated with a significantly lower risk of the primary endpoint compared to aspirin in overweight and obese patients (adjusted HRs: 0.51 for overweight, 0.69 for obese), with similar reductions for thrombotic events (HRs: 0.43 and 0.59, respectively). These findings were consistent in both categorical and spline-based analyses. No significant differences were observed between treatment groups for bleeding outcomes.
In stabilized post-PCI patients, clopidogrel was associated with improved long-term outcomes compared to aspirin in overweight and obese patients. Further studies are warranted to explore BMI-guided antiplatelet strategies.
This trial was registered at ClinicalTrials.gov (Registration number: NCT02044250). URL: https://clinicaltrials.gov/study/NCT02044250.
