Even high-risk patients undergoing stent procedures are safe without high-intensity drug therapy: study

A study has shown that high-risk patients who undergo stent procedures can safely avoid high-intensity drug therapy.

Asan Medical Center (ASM) announced on Wednesday that a research team, comprising Professors Park Duk-woo, Park Seung-jung, and Kang Do-yoon, along with specialist Wee Seong-bong from the hospital’s Department of Cardiology, analyzed the treatment outcomes over one year for 2,018 high-risk patients who underwent complex coronary stent procedures.

They divided the patients into a conventional treatment group and a customized treatment group. The results confirmed no significant difference in the incidence of major clinical events, including death, stroke, emergency reintervention, and bleeding, between the two groups.

Patients are classified as high-risk when their narrowed coronary lesions are located in the left main or branch segments, when severe calcification is present, when multiple stents are required for multivessel disease, or when they have comorbidities, including diabetes or kidney disease. These factors make the procedure complex and increase the risk of thrombosis after the procedure.

For such high-risk patients, the need for tailored therapy has been raised to minimize complications by implementing intensive drug therapy immediately after the procedure for active management.

The Asan Medical Center Cardiology Department research team randomly assigned 2,018 high-risk patients who underwent complex coronary stenting procedures into two groups: One thousand five patients in the customized therapy group received high-intensity drug therapy for six months post-procedure, followed by six months of low-intensity therapy. And 1,013 patients in the conventional therapy group received standard-intensity drug therapy uniformly for one year after coronary stent placement.

The customized therapy group combined ticagrelor and aspirin for six months, followed by clopidogrel alone for another six months. The standard therapy group combined clopidogrel and aspirin for 12 months.

The analysis showed that the incidence of major clinical events, including death, stroke, myocardial infarction, emergency reintervention, and bleeding, was 10.5 percent in the tailored therapy group and 8.8 percent in the standard therapy group, with no statistically significant difference between the two groups.

A closer look showed that the incidence of major ischemic events (death, stroke, stent thrombosis) was 3.9 percent in the personalized therapy group and 5.0 percent in the conventional therapy group, showing no significant difference. However, clinically significant bleeding occurred in 7.2 percent of the personalized therapy group and 4.8 percent of the conventional therapy group, demonstrating a significant increase in the personalized therapy group.

“There has been a global debate regarding the optimal drug therapy for high-risk patients undergoing complex coronary stent procedures. This large-scale study demonstrates that personalized therapy does not provide clinical benefits over conventional therapy,” said Professor Park Duk-woo, who presented the study at the European Society of Cardiology Annual Scientific Congress last Sunday.

He added, “As evidence for optimal thromboprophylaxis in high-risk stent patients remains relatively scarce, we will continue our research efforts to provide the optimal drug therapy for coronary artery disease patients.”

The study results were published in the globally authoritative “European Heart Journal” (Impact Factor 35.6)’ and presented at the “Hotline” main session of the “ESC Congress 2025,” the highest-authority conference in cardiology, held recently in Madrid, Spain.