IMPORTANCE Data on P2Y12 inhibitor monotherapy after short-duration dual antiplatelet therapy (DAPT) in patients undergoing percutaneous coronary intervention are limited. OBJECTIVE To determine whether P2Y12 inhibitor monotherapy after 3 months of DAPT is noninferior to 12 months of DAPT in patients undergoing PCI. DESIGN, SETTING, AND PARTICIPANTS The SMART-CHOICE trial was an open-label, noninferiority, randomized study that was conducted in 33 hospitals in Korea and included 2993 patients undergoing PCI with drug-eluting stents. Enrollment began March 18, 2014, and follow-up was completed July 19, 2018. INTERVENTIONS Patients were randomly assigned to receive aspirin plus a P2Y12 inhibitor for 3 months and thereafter P2Y12 inhibitor alone (n = 1495) or DAPT for 12 months (n = 1498). MAIN OUTCOMES AND MEASURES The primary end point was major adverse cardiac and cerebrovascular events (a composite of all-cause death, myocardial infarction, or stroke) at 12 months after the index procedure. Secondary end points included the components of the primary end point and bleeding defined as Bleeding Academic Research Consortium type 2 to 5. The noninferiority margin was 1.8%. RESULTS Among 2993 patients who were randomized (mean age, 64 years; 795 women [26.6%]), 2912 (97.3%) completed the trial. Adherence to the study protocol was 79.3% of the P2Y12 inhibitor monotherapy group and 95.2% of the DAPT group. At 12 months, major adverse cardiac and cerebrovascular events occurred in 42 patients in the P2Y12 inhibitor monotherapy group and in 36 patients in the DAPT group (2.9% vs 2.5%; difference, 0.4% [1-sided 95% CI,-ϱ% to 1.3%]; P = .007 for noninferiority). There were no significant differences in all-cause death (21 [1.4%] vs 18 [1.2%]; hazard ratio [HR], 1.18; 95% CI, 0.63-2.21; P = .61), myocardial infarction (11 [0.8%] vs 17 [1.2%]; HR, 0.66; 95% CI, 0.31-1.40; P = .28), or stroke (11 [0.8%] vs 5 [0.3%]; HR, 2.23; 95% CI, 0.78-6.43; P = .14) between the 2 groups. The rate of bleeding was significantly lower in the P2Y12 inhibitor monotherapy group than in the DAPT group (2.0% vs 3.4%; HR, 0.58; 95% CI, 0.36-0.92; P = .02). CONCLUSIONS AND RELEVANCE Among patients undergoing percutaneous coronary intervention, P2Y12 inhibitor monotherapy after 3 months of DAPT compared with prolonged DAPT resulted in noninferior rates of major adverse cardiac and cerebrovascular events. Because of limitations in the study population and adherence, further research is needed in other populations.

No abstract

Early conversion to SRL is associated with attenuated CAV progression and with lower long-term mortality and fewer CAV-related events compared with continued CNI use.

No abstract

Employing microfluorometric system and patch clamp technique in rabbit basilar arterial myocytes, regulation mechanisms of vascular excitability were investigated by applying intracellular pH (pH(i)) changers such as sodium acetate (SA) and NH(4)Cl. Applications of caffeine produced transient phasic contractions in a reversible manner. These caffeine-induced contractions were significantly enhanced by SA and suppressed by NH(4)Cl. Intracellular Ca(2+) concentration ([Ca(2+)](i)) was monitored in a single isolated myocyte and based the ratio of fluorescence using Fura-2 AM (R (340/380)). SA (20 mM) increased and NH(4)Cl (20 mM) decreased R (340/380) by 0.2 +/- 0.03 and 0.1 +/- 0.02, respectively, in a reversible manner. Caffeine (10 mM) transiently increased R (340/380) by 0.9 +/- 0.07, and the ratio increment was significantly enhanced by SA and suppressed by NH(4)Cl, implying that SA and NH(4)Cl may affect [Ca(2+)](i) (p < 0.05). Accordingly, we studied the effects of SA and NH(4)Cl on Ca(2+)-activated K(+) current (IK(Ca)) under patch clamp technique. Caffeine produced transient outward current at holding potential (V (h)) of 0 mV, caffeine induced transient outward K(+) current, and the spontaneous transient outward currents were significantly enhanced by SA and suppressed by NH(4)Cl. In addition, IK(Ca) was significantly increased by acidotic condition when pH(i) was lowered by altering the NH(4)Cl gradient across the cell membrane. Finally, the effects of SA and NH(4)Cl on the membrane excitability and basal tension were studied: Under current clamp mode, resting membrane potential (RMP) was -28 +/- 2.3 mV in a single cell level and was depolarized by 13 +/- 2.4 mV with 2 mM tetraethylammonium (TEA). SA hyperpolarized and NH(4)Cl depolarized RMP by 10 +/- 1.9 and 16 +/- 4.7 mV, respectively. SA-induced hyperpolarization and relaxation of basal tension was significantly inhibited by TEA. These results suggest that SA and NH(4)Cl might regulate vascular tone by altering membrane excitability through modulation of [Ca(2+)](i) and Ca(2+)-activated K channels in rabbit basilar artery.