Temporal modulation (early escalation and late de-escalation) of antiplatelet therapy in patients undergoing complex high-risk PCI: rationale and design of the TAILORED-CHIP trial

Hanbit Park¹, MD; Do-Yoon Kang², MD; Jung-Min Ahn², MD; Sung-Cheol Yun³, PhD; Kyoung-Ha Park⁴, MD; Se-Hun Kang⁵, MD; Jon Suh⁶, MD; Jang-Whan Bae⁷, MD; Sangwoo Park⁸, MD; Jang Hyun Cho⁹, MD; Jung-Won Suh¹⁰, MD; Bong-Ki Lee¹¹, MD; Seung-Woon Rha¹², MD; Hoyoun Won¹³, MD; Jae-Sik Jang¹⁴, MD; Moo Hyun Kim¹⁵, MD; Cheol Hyun Lee¹⁶, MD; Young Keun Ahn¹⁷, MD; Jun-Hyok Oh¹⁸, MD; Jae-Seok Bae¹⁹, MD; Chul Soo Park²⁰, MD; Jaewoong Choi²¹, MD; Jin-Bae Lee²², MD; Se-Whan Lee²³, MD; Sung-Ho Hur²⁴, MD; Osung Kwon²⁵, MD; Seung-Jung Park², MD; Duk-Woo Park², MD; on behalf of the TAILORED-CHIP trial investigators

1. Division of Cardiology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Republic of Korea; 2. Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea; 3. Division of Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea; 4. Division of Cardiovascular Disease, Hallym University Medical Center, Anyang, Republic of Korea; 5. Division of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, Repulic of Korea; 6. Division of Cardiology, Department of Internal Medicine, Soon Chun Hyang Bucheon Hospital, Soon Chun Hyang University College of Medicine, Bucheon, Republic of Korea; 7. Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University, Cheongju, Republic of Korea; 8. Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea; 9. Division of Cardiology, Saint Carollo Hospital, Suncheon, Republic of Korea; 10. Division of Cardiology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea; 11. Division of Cardiology, Department of Internal Medicine, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, Republic of Korea; 12. Cardiovascular Center, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea; 13. Cardiovascular and Arrhythmia Center, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea; 14. Department of Cardiology, Busan Paik Hospital, University of Inje College of Medicine, Busan, Republic of Korea; 15. Department of Cardiology, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Republic of Korea; 16. Division of Cardiology, Keimyung University Dongsan Hospital, Keimyung University College of Medicine, Daegu, Republic of Korea; 17. Division of Cardiology, Department of Medicine, Chonnam National University Hospital, Chonnam National University College of Medicine, Gwangju, Republic of Korea; 18. Division of Cardiology, Department of Internal Medicine, Medical Research Institute, Pusan National University Hospital, Pusan National University College of Medicine, Busan, Republic of Korea; 19. Division of Cardiology, Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Gyeongsang National University College of Medicine, Changwon, Republic of Korea; 20. Division of Cardiology, Department of Internal Medicine, Yeouido St. Mary’s Hospital College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea; 21. Division of Cardiology, Department of Internal Medicine, Nowon Eulji Medical Center, Eulji University College of Medicine, Seoul, Republic of Korea; 22. Division of Cardiology, Deagu Catholic University Medical Center, Deagu Catholic University College of Medicine, Deagu, Republic of Korea; 23. Department of Cardiology, Soon Chun Hyang Cheonan Hospital, Soon Chun Hyang University College of Medicine, Cheonan, Republic of Korea; 24. Department of Cardiology, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon, Republic of Korea; 25. Division of Cardiology, Department of Internal Medicine, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea

Abstract

Despite the use of conventional dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI), the risk of adverse events remains high among patients with increased thrombotic risk. Until recently, the optimal antiplatelet strategy to balance the ischaemic and bleeding risks in patients who are undergoing complex high-risk PCI has been unclear. The TAILored Versus COnventional AntithRombotic StratEgy IntenDed for Complex HIgh-Risk PCI (TAILORED-CHIP) trial is an investigator-initiated, multicentre, prospective randomised trial to evaluate the efficacy and safety of a time-dependent tailored antiplatelet therapy with an early (<6 months post-PCI) escalation (low-dose ticagrelor at 60 mg twice daily plus aspirin) and a late (>6 months post-PCI) de-escalation (clopidogrel monotherapy) in patients undergoing complex high-risk PCI as compared with standard DAPT (clopidogrel plus aspirin for 12 months). Eligible patients had to have at least one high-risk anatomical or procedural feature or clinical characteristic associated with an increased risk of ischaemic or thrombotic events. The primary endpoint was the net clinical outcome, a composite of death from any cause, myocardial infarction, stroke, stent thrombosis, urgent revascularisation, or clinically relevant bleeding (Bleeding Academic Research Consortium type 2, 3, or 5) at 12 months after randomisation. (ClinicalTrials.gov: NCT03465644)

Forgot your password?

No account yet?
Sign up for free!

Create my pcr account

Join us for free and access thousands of articles from EuroIntervention, as well as presentations, videos, cases from PCRonline.com