Percutaneous Coronary Intervention In China Research Articles

TCTAP A-170 Comparison of Hospital Costs for Women Undergoing Transradial Versus Transfemoral Percutaneous Coronary Intervention in China

TCTAP A-170 Comparison of Hospital Costs for Women Undergoing Transradial Versus Transfemoral Percutaneous Coronary Intervention in China

Abstract 001: Clinical Course After Elective Percutaneous Coronary Intervention in China: A Report From China PEACE Prospective Study of Percutaneous Coronary Interventions

Introduction: Despite remarkable growth in the use of percutaneous coronary intervention (PCI) in China over the past 30 years, little is known about the impact of PCI on patient’s health status. This study aims to describe the change in angina symptom and angina-related quality of life during the first year of recovery among Chinese patients undergoing elective PCI. Methods: We studied 2,252 patients undergoing elective PCI to 34 hospitals from December 2012 to August 2014 in the China PEACE Prospective Study of Percutaneous Coronary Intervention. Angina frequency and angina-related quality of life were assessed with the Seattle Angina Questionnaire (SAQ) at the time of hospitalization and 1 year later. Scores ranged from 0 to 100 points, with higher scores indicating fewer symptoms and better quality of life. We categorized both 1-year scores and changes in scores to facilitate clinical interpretability. We considered a clinically poor outcome at 1 year to be an angina frequency score ≤ 60 (daily/weekly angina) or quality of life score ≤ 50 (poor/fair quality of life). A 1-year change in score ≥ 5 was improvement, a change between -5 and 5 was interpreted as no change, and ≤ -5 was interpreted as being significantly worse at 1 year than before the PCI. Results: The average age of the cohort was 62.3 years (±10.0) and 33.4% were women. The response rate was about 74% and non-responders had similar characteristics compared with responders. At baseline, the mean angina frequency score (61.4±30.4) and quality of life score (55.7±23.9) were markedly low. 53.5% of patients had severe angina symptoms and 47.9% had poor quality of life. Over the year of recovery, a majority of patients experienced a clinically important improvement in angina (74.8%), 18.2% had no change, and 7.0% had worse symptoms. Similarly, 59.7% had significantly improved quality of life, 13.4% had no change, and 26.9% had worse quality of life. At 1 year after PCI, 6.2% of patients still had poor angina symptom and 26.4% had poor quality of life. Conclusion: Angina symptoms had greatly improved among most of the Chinese patients over the year following elective PCI, although the improvement in quality of life was relatively small. Future research is needed to characterize patients who have no improvement or have recession in angina symptoms and quality of life after PCI.

Symptom-Onset-To-Balloon Time, ST-Segment Resolution and In-Hospital Mortality in Patients With ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention in China: From China Acute Myocardial Infarction Registry

Animal and imaging study evidence favors early reperfusion for acute myocardial infarction. However, in clinical trials, the effect of symptom-onset-to-balloon (S2B) time on clinical outcomes in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI) has been inconsistent. Moreover, there are few data regarding the ischemic time in China. A total of 3,877 consecutive patients with STEMI with available S2B time undergoing pPCI from January 2013 to September 2014 at 108 hospitals that participated in the China Acute Myocardial Infarction registry were included and stratified into 3 S2B groups: <6hours, 6 to 12hours, >12hours S2B time was tested in multivariate logistic regression analyses as an independent risk factor of mortality (primary outcome), major adverse cardiovascular and cerebrovascular events (MACCE), and impaired myocardial perfusion (secondary outcomes). The median S2B time was 5.5 (3.75 to 8.50) hours. Longer S2B time was associated with higher in-hospital mortality (<6hours: 2.7%; 6 to 12hours: 3.4%; >12hours: 4.9%; p= 0.047) and ST-segment resolution <50% (<6hours: 16.7%; 6 to 12hours: 19.2%; >12hours: 24.3%; p= 0.002) but not MACCE. In multivariate-adjusted analysis, S2B >12hours remained associated with ST-segment resolution <50% (odds ratio 1.53, 95% confidence interval 1.16 to 2.01, p= 0.002) but not with in-hospital mortality (odds ratio 1.673, 95% confidence interval 0.95 to 2.94, p= 0.073). In conclusion, median S2B time in patients with STEMI undergoing pPCI was longer than that in registry studies from other countries. Longer S2B time was associated with impaired myocardial perfusion but not with in-hospital mortality or MACCE.

Quality evaluation of literature of randomized controlled trials on oral hydration for prevention of acute kidney injury after percutaneous coronary intervention in China

Objective To understand the quality of literature of randomized controlled trials(RCTs) on oral hydration for prevention of acute kidney injury after percutaneous coronary intervention published(PCI) in journals in China. Methods Literature of RCTs on oral hydration for prevention of acute kidney injury after PCI published in journals in China was searched in CBM, CNKI, Wan Fang data, and VIP database. And then, they were screened according to the inclusion and exclusion criteria. Besides, the quality of literature was evaluated based on the Cochrane collaboration′s tool for assessing risk of bias and the Jadad scale. Results A total of 10 RCTs were included. The results of the Cochrane collaboration′s tool for assessing risk of bias showed that there was no document to describe whether the data of subjects without completing the trail were analyzed with intentional analysis, random allocation concealment, blinding of participants and outcome assessment and so on. Moreover, the score of Jadad was less than two. There was only one document which mentioned the word 'random’ without involving specific randomized methods, one document which explained the blind method, no document which reported the case that withdrew from the trail and was lost. Conclusions The quality of literature of RCTs on oral hydration for prevention of acute kidney injury after PCI published in journals in China is low. Because of this, high quality researches should be conducted so as to provide good guidance for clinical practice. Key words: Randomized controlled trial; Percutaneous coronary intervention; Oral hydration; Acute kidney injury; Literature quality evaluation

Costs and Benefits Associated With Transradial Versus Transfemoral Percutaneous Coronary Intervention in China.

BackgroundTransradial percutaneous coronary intervention (PCI) has been increasingly adopted in clinical practice, given its potential advantages over transfemoral intervention; however, the impact of different access strategies on costs and clinical outcomes remains poorly defined, especially in the developing world.Methods and ResultsUsing data from a consecutive cohort of 5306 patients undergoing PCI in China in 2010, we compared total hospital costs and in‐hospital outcomes for transradial intervention (TRI) and transfemoral intervention. Patients receiving TRI (n=4696, 88.5%) were slightly younger (mean age 57.4 versus 59.5 years), less often women (21.6% versus 33.1%), more likely to undergo PCI for single‐vessel disease, and less likely to undergo PCI for triple‐vessel or left main diseases. The unadjusted total hospital costs were 57 900 Chinese yuan (¥57 900; equivalent to 9190 US dollars [$9190]) for TRI and ¥67 418 ($10,701) for transfemoral intervention. After adjusting for all observed patient and procedural characteristics using the propensity score inverse probability weighting method, TRI was associated with a lower total cost (adjusted difference ¥8081 [$1283]). More than 80% of the cost difference was related to lower PCI‐related costs (adjusted difference −¥5162 [−$819]), which were likely driven by exclusive use of vascular closure devices in transfemoral intervention, and lower hospitalization costs (−¥1399 [−$222]). Patients receiving TRI had shorter length of stay and were less likely to experience major adverse cardiac events or post‐PCI bleeding. These differences were consistent among clinically relevant subgroups with acute myocardial infarction, acute coronary syndrome, and stable angina.ConclusionsAmong patients undergoing PCI, TRI was associated with lower cost and favorable clinical outcomes compared with transfemoral intervention.

Coronary Catheterization and Percutaneous Coronary Intervention in China: 10-Year Results From the China PEACE-Retrospective CathPCI Study.

The use of coronary catheterization and percutaneous coronary intervention (PCI) is increasing in China, but, to date, there are no nationally representative assessments of the quality of care and outcomes in patients undergoing these procedures. To assess the quality of care and outcomes of patients undergoing coronary catheterization and PCI in China. In a clinical observational study (China PEACE [Patient-Centered Evaluative Assessment of Cardiac Events]-Retrospective CathPCI Study), we used a 2-stage, random sampling strategy to create a nationally representative sample of 11 241 patients undergoing coronary catheterization and PCI at 55 urban Chinese hospitals in calendar years 2001, 2006, and 2011. Data analysis was performed from July 11, 2014, to November 20, 2015. Patient characteristics, treatment patterns, quality of care, and outcomes associated with these procedures and changes over time. Of the 11 241 patients included in the study, the samples included, for 2001, 285 women (weighted percentage, 28.6%); for 2006, 826 women (weighted percentage, 32.2%), and for 2011, 2588 women (weighted percentage, 35.7%). Mean (SD) ages were 58 (8), 60 (11), and 61 (11) years, respectively. Between 2001 and 2011, estimated national rates of hospitalizations for coronary catheterization increased from 26 570 to 452 784 and for PCI, from 9678 to 208 954 (17-fold and 21-fold), respectively. More than half of stable patients undergoing coronary catheterization had nonobstructive coronary artery disease; this amount did not change significantly over time (2001: 60.3% [95% CI, 56.1%-64.5%]; 2011: 57.5% [95% CI, 55.8%-59.3%], P = .05 for trend). The proportion of PCI procedures performed via radial approach increased from 3.5% (95% CI, 1.7%-5.3%) in 2001 to 79.0% (95% CI, 77.7%-80.3%) in 2011 (P < . 001 for trend). The use of drug-eluting stents (DESs) increased from 18.0% (95% CI, 14.2%-21.7%) in 2001 to 97.3% (95% CI, 96.9%-97.7%) in 2011 (P < .001 for trend) largely owing to increased use of domestic DESs. The median length of stay decreased from 14 days (interquartile range [IQR], 9-20) in 2001 to 10 days (IQR, 7-14) in 2011 (P < .001 for trend). In-hospital mortality did not change significantly, but both adjusted risk of any bleeding (odds ratio [OR], 0.53 [95% CI, 0.36-0.79], P < .001 for trend) and access bleeding (OR, 0.23 [95% CI, 0.12-0.43], P < .001) were decreased between 2001 and 2011. The medical records lacked documentation needed to calculate commonly used process metrics including door to balloon times for primary PCI and the prescription of evidence-based medications at discharge. Although the use of catheterization and PCI in China has increased dramatically, we identified critical quality and documentation gaps that represent opportunities to improve care. Our findings can serve as a foundation to guide future quality improvement initiatives in China.

Abstract 161: National Trends in Use of Radial Access for Percutaneous Coronary Intervention in China: 2001-2011

Background: The use of radial access for percutaneous coronary intervention (r-PCI) is associated with reduced risk of bleeding complications and higher patient satisfaction. However, the use of r-PCI differs greatly by country and is unknown in China. We examined trends in the adoption of r-PCI in China over the past decade and identified factors associated with its use. Methods: We used a two-stage random sampling strategy to create a nationally representative sample of 5,462 patients undergoing percutaneous coronary intervention (PCI) in China in 2001 (n=402; 24 sites), 2006 (n=1,390; 44 sites), and 2011 (n=3,670; 54 sites). We calculated the weighted proportion of patients receiving r-PCI in each time period and conducted multivariable analysis to identify the patient and hospital characteristics associated with not receiving r-PCI in 2011. Results: Among 5,462 patients who underwent PCI, the use of r-PCI increased markedly over time (2001: 3.4% [95% CI 0.0%-8.5%]; 2006: 36.5% [95% CI 34.2%-38.9%], 2011: 74.7% [95% CI 73.9-75.6]; P for trend &lt;0.001). Increases in r-PCI use were widespread, including high-risk subgroups such as the elderly, women, and patients with acute coronary syndromes (Figure). In multivariable analysis of 3,670 patients undergoing PCI in 2011, cardiogenic shock and emergency PCI were strongly associated with failure to use r-PCI in 2011. Conclusion: Over a recent ten-year period, radial access became the predominant strategy for PCI in China, even among high-risk patients. This study demonstrates the responsiveness of the interventional cardiology community to emerging evidence. A deeper understanding of the factors facilitating r-PCI adoption in China may help increase its usage in countries in which r-PCI use remains low.

Abstract 377: The China Patient-Centered Evaluative Assessment of Cardiac Events (PEACE) Prospective Study of Percutaneous Coronary Intervention: Study Design

Background: The volume of percutaneous coronary intervention (PCI) in China has increased more than 20-fold over the last decade. Consequently, there is a need for national-level information to characterize indications for PCI and its long-term outcomes, including health status improvement, which is the principal goal of PCI in stable patients. Objectives: To conduct a nationwide prospective study of patients receiving PCI and follow them to 1) measure long-term clinical outcomes, patient-reported outcomes (PROs), risk factor control and adherence to medications for secondary prevention; 2) determine patient- and hospital-level factors associated with these outcomes; and 3) assess indications for and appropriateness of the PCI procedures performed. Methods: The China PEACE Prospective Study of PCI, conducted from December 2012 to December 2014, has recruited 5000 consecutive patients undergoing PCI for any indication from 36 representative hospitals across China and followed them for 1-year. The follow-up rate at 12 months was 94%. After obtaining informed consent from each patient, we abstracted details of their medical history, treatments, and in-hospital outcomes from medical charts. We conducted baseline interviews to characterize patient demographics, risk factors, clinical presentation, and healthcare utilization. In addition, we used several validated instruments to measure PROs describing quality of life, symptoms, mood and sleep. The primary outcome, a composite measure of death, myocardial infarction and/or revascularization, was assessed at follow-up interviews conducted at 1-, 6- and 12-months after discharge. In addition, we measured PROs, medication adherence and risk factor control at these interviews. Blood and urine samples were collected at the 1- and 12-month interviews and stored for future analysis. To establish the appropriateness of PCI, the angiograms of 2000 randomly selected patients were reviewed by independent “core” labs in China and the United States. To complement these patient-level data, we surveyed participating hospitals to characterize their facilities, processes and organizational learning culture. Conclusion: This study will generate novel, high-quality, and comprehensive national data characterizing the patient experience after PCI in China.

Abstract 317: Costs and Benefits Associated with Transradial Percutaneous Coronary Intervention in China

Background: Transradial percutaneous coronary intervention (TRI) has been increasingly used in the treatment of ischemic heart disease. While there are few studies examining the costs and benefits of transradial vs. transfemoral (TFI) in experienced centers among highly selected patients, treatment patterns and cost data obtained from the United States and European countries might not be generalizable to the developing world. Methods: We performed a retrospective analysis of patients undergoing PCI in the largest heart center in China between January and December 2010. Propensity score inverse probability weighting (IPW) method was used to compare costs and in-hospital outcomes between TRI and TFI, while controlling for potential treatment selection inherent in observational research. Results: Of 5,307patients undergoing PCI, 4,684 (88.3%) received TRI. Those undergoing TRI were younger, were less likely to be female, less likely to have prior myocardial infarction, PCI, or CABG, and more often presented with STEMI. After IPW adjustment, TRI was associated with fewer bleeding complications (BARC≥3 0.7% vs. 2.2%, OR 0.36, 95% CI 0.18-0.68), major adverse cardiovascular event (a composite of death, myocardial infarction, BARC bleeding≥3 or unplanned revascularization; 1.8% vs. 4.0%, OR 0.49, 95% CI 0.31-0.79), and shorter length of stay (6.1 vs 8.3 days, adjusted difference -1.5 days, 95% CI -1.9 to -1.2; Table ). TRI was associated with a cost saving of $1,261 (95% CI $967-$1,557) as compared with TFI. The cost saving was mainly driven by reduced procedural-related cost ($761) from differential use of vascular closure device and lower hospitalization cost ($217) related to shorter length of stay. Similar results were found in clinically relevant groups of myocardial infarction (STEMI and NSTEMI), acute coronary syndrome (STEMI, NSTEMI, and unstable angina), and stable angina. Conclusions: Compared with the TFI approach, TRI was associated with fewer complications, shorter length of stay, lower costs, and improved in-hospital outcomes.

Zotarolimus- and Paclitaxel-Eluting Stents in an All-Comer Population in China: The RESOLUTE China Randomized Controlled Trial

This study sought to compare clinical outcomes and angiographic findings using the Resolute zotarolimus-eluting stent (R-ZES) (Medtronic, Santa Rosa, California) versus the Taxus Liberte paclitaxel-eluting stent (PES) (Boston Scientific, Natick, Massachusetts) in an all-comer Chinese population. Concerns regarding restenosis risk led to new-generation drug-eluting stents (DES) designed for use in patients with complex clinical or lesion characteristics. In-stent late lumen loss (LLL) is a measure of restenosis risk. Patients with an indication for treatment with a DES were randomized in a 1:1 ratio to placement of at least 1 R-ZES or PES with minimal exclusions. The primary endpoint was angiographic in-stent LLL at 9 months post-procedure. Clinical endpoints at 12 months are compared between the 2 stents. A total of 198 patients received a R-ZES, and 202 patients received a PES. Most patients were male; 25.8% and 29.2% of R-ZES and PES patients, respectively, had diabetes. Over 70% of lesions in both cohorts were American College of Cardiology/American Heart Association lesion classification Type B2 and C (B2/C). In-stent LLL was 0.16 ± 0.38 mm for R-ZES and 0.33 ± 0.52 mm for PES at 9 months (p < 0.001; 95% confidence interval [CI]: -0.26 to -0.08). The rates of clinically driven target lesion revascularization were 1.5% for R-ZES and 7.0% for PES (p = 0.011). The rate of target lesion failure was 5.6% for R-ZES and 11% for PES (p = 0.068). In an all-comers Chinese population, 9-month in-stent LLL was significantly less with R-ZES compared with PES, which was reflected in lower revascularization rates at 12 months for the R-ZES patients. Results are consistent with previous clinical trials of the R-ZES in all-comer populations. (Resolute Zotarolimus-Eluting Stent Versus the Taxus Liberte Paclitaxel-Eluting Stent for Percutaneous Coronary Intervention in China [R-China RCT]; NCT01334268).

Erratum to: Current status and development of percutaneous coronary intervention in China

Erratum to: J Zhejiang Univ-Sci B (Biomed & Biotechnol) 2010 11(8):631-633 doi:10.1631/jzus.B1001012. The online version of the original article can be found at http://dx.doi.org/10.1631/jzus.B1001012. The original version of this article unfortunately contained a mistake. In the 6th paragraph of Section “4 Evaluation of PCI status in 2009”, the underlined data in “Online data showed that unstable angina, non-ST elevation myocardial infarction (NSTEMI), and ST elevation myocardial infarction (STEMI) occupied 54%, 29%, and 6% of the total PCI cases, respectively, 79% when added together.” were incorrect. The correct version is given below: Online data showed that unstable angina, non-ST elevation myocardial infarction (NSTEMI), and ST elevation myocardial infarction (STEMI) occupied 54%, 6%, and 29% of the total PCI cases, respectively, 89% when added together.

Current status and development of percutaneous coronary intervention in China

Dr. Gruntzig et al. (1979) successfully completed the world's first percutaneous coronary intervention (PCI), a percutaneous transluminal coronary angioplasty (PTCA), in 1977. The first reported PTCA in China was in 1984. With the development of PCI techniques, while more and more patients have benefited, there are ongoing challenges as well.

Current status of percutaneous coronary intervention in China

Since the introduction of percutaneous transluminal coronary angioplasty (PTCA) into China in 1985 with a first report in 1986,1 there has been exponential growth in annual numbers of percutaneous coronary...

Design and rationale of a study in Asia of atorvastatin pretreatment in patients undergoing percutaneous coronary intervention for non-ST elevation acute coronary syndromes

Studies in Western populations have shown the benefits of pretreatment with atorvastatin in preventing cardiovascular events in patients, including those with acute coronary syndromes (ACS), undergoing percutaneous coronary intervention (PCI). However, data concerning the value of such therapy in Asian patients are limited. The primary objective of the present study is to evaluate the efficacy of atorvastatin in reducing cardiovascular outcomes in Asian patients with non-ST-segment elevation (NSTE)-ACS following hospital admission for early PCI (within 72 h of the onset of symptoms). Secondary objectives are to assess the effects of atorvastatin on cardiac biomarker levels, and the safety and tolerability profile of atorvastatin. This study is a prospective, multicenter, open-label trial designed to enroll 350 statin-naïve patients with NSTE-ACS scheduled for PCI in China and the Republic of Korea. Patients are randomized to either usual care or atorvastatin treatment groups, with patients in both treatment groups receiving usual care including atorvastatin 40 mg/day for 30 days post-PCI. Patients in the atorvastatin group receive additional doses of atorvastatin 80 mg at 12 h pre-PCI and 40 mg at 2 h pre-PCI. The primary end point is the incidence of major adverse cardiac events (death, myocardial infarction, and target vessel revascularization) at 30 days post-PCI. The present study will provide valuable insights into whether the benefits of atorvastatin pretreatment extend to Asian patients with ACS undergoing interventions. Enhanced treatment of these patients will be an important contribution towards alleviating the increasing burden of cardiovascular disease in Asian countries.

Current status and perspective of percutaneous coronary intervention in China

Current status and perspective of percutaneous coronary intervention in China

XS0601 reduces the incidence of restenosis: a prospective study of 335 patients undergoing percutaneous coronary intervention in China

XS0601, consisting of active ingredients (Chuangxiongol and paeoniflorin), has been shown to inhibit arterial neointimal hyperplasia in animal models and in preliminary human studies. The objective of this study was to evaluate the safety and efficacy of XS0601 in preventing restenosis following percutaneous coronary intervention (PCI). A multi-center, randomized, double-blind, placebo-controlled trial was conducted. A total of 335 patients were randomized into treatment with the oral administration of XS0601, or a placebo for 6 months after successful PCI. Angiographic follow-up was scheduled at 6 months, and clinical follow-ups performed at 1, 3 and 6 months after PCI. The primary end point was angiographic restenosis. The secondary end points were the combined incidence of death, target lesion nonfatal myocardial infarction, repeat angioplasty, and coronary artery bypass graft surgery. A total of 308 patients (91.9%) completed the study and 145 cases (47.1%) received angiographic follow-up. The restenosis rates were significantly reduced in the XS0601 group as compared with the placebo group (26.0% vs. 47.2%, P < 0.05), and the minimum lumen diameter (MLD) was greater [(2.08 +/- 0.89) mm for XS0601 vs. (1.73 +/- 0.94) mm for placebo, P < 0.05]. XS0601 also significantly reduced the combined incidence of major adverse cardiac event (10.4% in the XS0601 group vs. 22.7% in the placebo group, P < 0.05). The incidence of recurrent angina at 3 and 6 months after PCI was also significantly reduced in XS0601 group (7.1% and 11.0%) as compared with those in placebo group (19.5% and 42.9%) (P < 0.05). No significant side effects occurred within the 6-month follow-up period in the XS0601 group. Administration of XS0601 for 6 months is demonstrated to be safe and effective in reducing restenosis in post-PCI patients.

JOURNAL SCAN

Monotherapy with either aspirin or clopidogrel is recommended for long-term use after discontinuation of dual-antiplatelet therapy (DAPT) for acute coronary syndrome (ACS) management after percutaneous coronary intervention (PCI). The present study is to evaluate the cost-effectiveness of clopidogrel versus aspirin after 12-month DAPT for patients with ACS who underwent PCI in China.A 2-part model was developed to estimate the cost-effectiveness of clopidogrel compared with aspirin. The short-term part was a decision tree that included health states such as myocardial infarction (MI), stroke, MI and stroke, cardiovascular death, and death from other causes with a treatment horizon of 1 year (base case), 2 years or 3 years after 12-month DAPT. Major bleeding was included. The long-term (lifetime) part was a Markov model that included different health states such as MI, after MI, stroke, after stroke, and death. Drug acquisition cost and other direct medical costs were based on pricing records, literature, and expert panels. Clinical outcomes and utilities were based on literature. The model output included incremental cost-effectiveness ratio of quality-adjusted life-years (QALYs) and total costs per patient. Both 1-way sensitivity analysis and probabilistic sensitivity analysis (PSA) were conducted.In the base–case scenario, the total costs of the treatment with clopidogrel and aspirin were ¥12,590 ($1849/€1590) and ¥10,642 ($1563/€1344), respectively; the total QALYs of the 2 patient populations were 9.7341 and 9.6894, respectively. The incremental cost-effectiveness ratio of ¥43,593 ($6402/€5515) per QALY gained was lower than 3 times of gross domestic product (GDP) per capita in China (¥161,940, $23,786/€20,449). Both 1-way sensitivity analysis and PSA confirmed the robustness of the results. PSA results indicated that clopidogrel was cost effective versus aspirin in 80.5% of the simulations, considering >3 times the GDP per capita as the threshold. Results in other scenarios (clopidogrel or aspirin for 2 or 3 years after 12-month DAPT) also indicated that clopidogrel was more cost effective than aspirin for patients with ACS after 12-month DAPT.Compared with aspirin monotherapy, clopidogrel monotherapy for 1 year after 12-month DAPT was cost effective for patients with ACS who underwent PCI in China. Furthermore, when the duration of clopidogrel the monotherapy extended up to 3 years, clopidogrel was still cost effective compared with aspirin. The study was limited by lack of high-quality efficacy data among the Chinese population.