HOST-EXAM Trial: 10-Year
Follow-Up
Published: March 29, 2026 | The
Lancet
Authors: Koo BK, Kang J, Park KW, et al.
Trial Registration: NCT02044250
| Component |
Details |
| P - Population |
Adults who completed 12±6 months DAPT after DES-PCI without clinical
events (East Asian, mean age 63.5, 25% female) |
| I - Intervention |
Clopidogrel monotherapy 75 mg/day (n=2,710) |
| C - Comparison |
Aspirin monotherapy 100 mg/day (n=2,728) |
| O - Outcome |
Composite: all-cause death, non-fatal MI, stroke, ACS readmission,
major bleeding |
Key Results: 10-Year
Follow-Up
| Outcome |
Clopidogrel |
Aspirin |
ARR |
p-value |
| Primary Composite |
25.4% |
28.5% |
3.1% |
<0.01 |
| Stroke |
4.6% |
6.4% |
1.8% |
<0.01 |
| Major Bleeding |
5.6% |
7.7% |
2.1% |
<0.01 |
| ACS Readmission |
8.7% |
11.0% |
2.3% |
<0.01 |
Timeline of Results
| Follow-up |
Publication |
HR |
p-value |
| 24 months |
Lancet 2021 |
0.73 |
0.003 |
| 5.8 years |
Circulation 2023 |
0.74 |
<0.001 |
| 10 years |
Lancet 2026 |
— |
<0.01 |
Clinical Implications
- ✅ Biphasic benefit: Reduces both thrombotic AND
bleeding risks simultaneously
- ✅ Longest randomized comparison of antiplatelet monotherapy to
date
- ✅ Supports clopidogrel as alternative to aspirin for long-term
secondary prevention post-PCI
Limitations
- ⚠️ Study population: East Asian patients only
- ⚠️ Clopidogrel resistance not assessed
- ⚠️ Generalizability to other populations unclear
References
- Koo BK, et al. HOST-EXAM. Lancet 2021;397:2487-96
- Kang J, et al. HOST-EXAM Extended. Circulation
2023;147:108-17
- Kang J, et al. HOST-EXAM 10-year. Lancet 2026 (Published
March 29, 2026)
Full Article:
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)01063-1/fulltext