Background: Clopidogrel requires several hours to achieve adequate platelet inhibition. We investigated the association of clopidogrel preloading time with 30-day clinical outcomes and post-procedural troponin elevation in patients with stable angina undergoing elective percutaneous coronary intervention (PCI). Methods: This single-center retrospective cohort study included 1,020 patients with stable angina (clopidogrel-naive) who received 300 mg clopidogrel preloading within 24 hours before elective PCI between 2012 and 2020. Patients were categorized according to clopidogrel preloading-to-balloon time ≤6 hours or >6 hours. The primary endpoint was 30-day major adverse cardiovascular events (MACE), defined as a composite of all-cause death, myocardial infarction, stroke, and any revascularization. Secondary endpoints included serial troponin T changes and troponin T elevation ≥5×, ≥25×, and ≥70× the upper reference limit. Stabilized inverse probability of treatment weighting (IPTW) was used. Results: Thirty-day MACE occurred in five patients (0.49%) and did not differ between the ≤6-hour and >6-hour groups after IPTW (0.5% vs. 0.4%, p=0.754). Post-procedural troponin T levels at 6, 24, and 48 hours were higher in the ≤6-hour group. Patients with shorter preloading-to-balloon times showed higher peak troponin T levels, with the greatest difference at the ≤1-hour cutoff (geometric mean ratio, 2.12; 95% confidence interval, 1.53–2.95; p<0.001) and progressive attenuation at longer cutoffs. Troponin T elevation ≥5× and ≥25× was more frequent in the ≤6-hour group, whereas ≥70× elevation did not differ. Conclusion Clopidogrel preloading ≤6 hours before elective PCI was not associated with increased 30-day MACE but was associated with lower-threshold post-procedural troponin T elevation.

Background: Dual antiplatelet therapy with aspirin and a P2Y12 inhibitor is standard after percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS); however, bleeding risk remains a major concern. Early discontinuation of aspirin due to potent P2Y12 inhibition may mitigate bleeding without increasing thrombotic events. Methods: The ASpirin-FREE therapy after successful percutaneous coronary intervention for acute coronary syndrome (ASFREE) study was an investigator-initiated, single-center, prospective, open-label, single-arm pilot study enrolling patients with ACS who underwent PCI with drug-eluting stents. All patients received a single loading dose of aspirin on the day of the PCI, followed by ticagrelor or prasugrel monotherapy. The primary efficacy endpoint was target vessel failure (TVF) at 12 months. The primary safety endpoint was definite stent thrombosis. Event rates are reported with 95% confidence intervals (CIs). Results: In total, 228 patients were enrolled. TVF occurred in 10 patients (4.4%; 95% CI, 2.1%–7.9%). Definite stent thrombosis was observed in one patient (0.4%; 95% CI, 0.01%–2.4%), with no acute or subacute events. Major bleeding (Bleeding Academic Research Consortium type 3 or 5) occurred in two patients (0.9%; 95% CI, 0.1%–3.1%). Conclusion An aspirin-free strategy following a single loading dose with continuation of potent P2Y12 inhibitor monotherapy was feasible in patients with ACS undergoing PCI and was associated with low rates of thrombotic and major bleeding events. These findings should be regarded as hypothesis-generating and supporting further evaluations in adequately powered randomized controlled trials (CRIS registration: KCT0008182).

Purpose: To compare the long-term effects of two preservative-free 0.005% latanoprost ophthalmic solutions with different excipient compositions on intraocular pressure (IOP), conjunctival hyperemia, and subjective ocular discomfort. Methods: The medical records of patients newly diagnosed with normal tension glaucoma or primary open angle glaucoma who started treatment using Xalost S® or Monoprost® were reviewed. IOP was measured with Goldmann applanation tonometry. Conjunctival hyperemia was measured with a Keratograph® 5M and subjective ocular discomfort was surveyed using a visual analog scale. Routine examinations were scheduled 1 week and 1, 3, 6, and 12 months after treatment. A generalized estimating equation was used to evaluate the changes of these parameters with time. Results: Xalost S® was used in 31 patients (60 eyes) and Monoprost® in 27 patients (50 eyes). The baseline characteristics were generally similar in the two groups with no significant differences. In the Xalost S® group, the IOP difference from baseline was significant at all time points (p < 0.001). However, in the Monoprost® group, after 1 month of treatment, the IOP difference decreased significantly (p = 0.054 at 1 week; p = 0.005 at 1 month; p < 0.001 after 1 month). Conjunctival hyperemia and subjective ocular discomfort did not differ significantly from baseline in either group. Conclusions There was no significant difference in the frequency of side effects between the two drugs. The effect on the IOP drop was similar over time, but the initial IOP drop was greater in the Xalost S® group. This difference is presumed to be due to the different excipient compositions of the two drugs.