Abbreviated dual antiplatelet therapy after percutaneous coronary intervention with ultrathin-strut drug-eluting stents in South Korea - 3-year outcomes of the multicentre, randomised HOST-IDEA trial

Sep 30, 2026

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The HOST-IDEA trial assessed whether abbreviated dual antiplatelet therapy (DAPT) after percutaneous coronary intervention with third-generation drug-eluting stents yields sustained long-term safety and effectiveness. In a multicentre randomized design conducted in South Korea, patients received either 3-to-6-month DAPT or 12-month DAPT, with event-based outcomes evaluated at 3 years, including major bleeding and net adverse clinical events.

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Articles Abbreviated dual antiplatelet therapy after percutaneous coronary intervention with ultrathin-strut drug-elutingstents in South Korea: 3-year outcomes of the multicentre, randomised HOST-IDEA trial Jung-Kyu Han,a,b,o Doyeon Hwang,a,o Seokhun Yang,a Sang-Hyeon Park,a Jeehoon Kang,a Han-Mo Yang,a,b Kyung Woo Park,a,b Hyun-Jae Kang,a,b Bon-Kwon Koo,a,b Seung-Ho Hur,c Weon Kim,d Seok Yeon Kim,e Sang-Hyun Park,f Seung Hwan Han,g Sang-Hyun Kim,h Sanghoon Shin,i Kyungil Park,j Seung Jin Lee,k Jin Won Kim,l Namho Lee,m,∗∗ and Hyo-Soo Kimn,∗ aCardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea bDepartment of Internal Medicine, College of Medicine, Seoul National University, Seoul, Republic of Korea cDepartment of Internal Medicine, Keimyung University Dongsan Hospital, Daegu, Republic of Korea dDivision of Cardiology, Department of Internal Medicine, Kyung Hee University Hospital, Seoul, Republic of Korea eDepartment of Cardiology, Cardiovascular Center, Seoul Medical Center, Seoul, Republic of Korea fDepartment of Internal Medicine, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon, Republic of Korea gDivision of Cardiology, Department of Internal Medicine, Gachon University Gil Hospital, Incheon, Republic of Korea hDivision of Cardiology, Department of Internal Medicine, Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea iDepartment of Cardiology, Seoul Hospital, Ewha Womans University College of Medicine, Seoul, Republic of Korea jDepartment of Internal Medicine, Dong-A University College of Medicine, Busan, Republic of Korea kDivision of Cardiology, Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Republic of Korea lCardiovascular Center, Guro Hospital Korea University, Seoul, Republic of Korea mDepartment of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Seoul, Republic of KoreanSeoul National University Hospital, Republic of Korea Summary Background The HOST-IDEA trial demonstrated non-inferiority of 3-to-6-month dual antiplatelet therapy (DAPT) to 12-month DAPT for net adverse clinical event (NACE) at 1 year in patients undergoing percutaneous coronary intervention (PCI) with third-generation drug-eluting stents (DES) . We evaluated the long-term outcomes of abbreviated antiplatelet therapy following PCI with third-generation DES. Methods In the open-label, adjudicator-blinded, multicentre, randomised HOST-IDEA trial, 2013 patients from 37 hospitals in South Korea were randomly allocated to 3-to-6-month (n = 1002) or 12-month (n = 1011) DAPT between January 2016 and May 2021. The primary outcome was NACE at 3 years, comprising cardiac death, target vessel myocardial infarction (TVMI), clinically driven target lesion revascularisation (CD-TLR), stent thrombosis, and major bleeding (Bleeding Academic Research Consortium type 3 or 5) . Major secondary outcomes were target lesion failure (TLF)—comprising cardiac death, TVMI, and CD-TLR—and major bleeding at 3 years. To evaluate the efficacy and safety of >1-year DAPT, patients event-free at 1 year were classified into >1-year and ≤1-year DAPT groups and matched using a propensity score. These 3-year clinical outcomes were prespecified in the published protocol as mandatory clinical follow-up. HOST-IDEA is registered with [ClinicalTrials.gov](ClinicalTrials.gov), NCT02601157 . Findings At 3 years, clinical follow-up was completed in 955 patients (95.3%) and 966 patients (95.5%) in the 3-to-6-month and 12-month DAPT groups, respectively. The median follow-up duration was 1095 days (IQR 1095–1095) . The primary outcome occurred in 7.7% and 8.2% of patients in the 3-to-6-month and 12-month DAPT groups, respectively (HR 0.94; 95% CI 0.69–1.29; P = 0.71) . The risks of TLF (HR 0.92; 95% CI 0.62–1.36; P = 0.66) and major bleeding (HR 0.96; 95% CI 0.59–1.56; P = 0.88) were comparable between the tw

FAQs

What was the main purpose of the HOST-IDEA long-term analysis?

To evaluate long-term outcomes of abbreviated antiplatelet therapy following PCI using third-generation drug-eluting stents, extending follow-up to 3 years.

How were patients assigned to different DAPT durations?

Patients in the open-label, adjudicator-blinded, multicentre randomized HOST-IDEA trial were allocated to 3-to-6-month DAPT or 12-month DAPT between January 2016 and May 2021.

What were the 3-year results for the primary outcome (NACE)?

At 3 years, the primary outcome occurred in 7.7% with 3-to-6-month DAPT and 8.2% with 12-month DAPT (HR 0.94; 95% CI 0.69–1.29; P = 0.71), showing comparable outcomes.

Did extending DAPT beyond 1 year improve ischemic outcomes?

Extending DAPT beyond 1 year was not associated with additional ischemic benefits, while major bleeding risk was significantly higher in the >1-year DAPT group (HR 4.44; 95% CI 1.26–15.57; P = 0.02).

Sep 30, 2026

Uploaded by Patrick