Asan Medical Center Compares Outcomes of Personalized Therapy with High Intensity Drug Treatment Immediately After Stent Procedures

No Significant Difference in Major Clinical Events such as Death or Stroke between Standard and Personalized Therapy

Findings Presented at the Main Session of the European Society of Cardiology and Published Simultaneously in the European Heart Journal

▲ (From left) Professor Duk-Woo Park, Endowed-Chair Professor Seung-Jung Park, and Professor Do-Yoon Kang, along with Clinical Fellow Seong Bong Wee from the Division of Cardiology at Asan Medical Center

Coronary stenting is widely performed to widen narrowed or blocked coronary arteries, which supply blood to the heart. To prevent blood clots from forming at the site of stent placement, patients must take antiplatelet medication.

For high risk patients, such as those with anatomically complex lesions that are difficult to treat or those with comorbidities like diabetes, there has been a growing call for personalized therapy involving high intensity drug treatment immediately after the procedure to reduce complications. However, it has not been clearly determined whether standard therapy or personalized therapy is more effective for these high risk patients.

Professor Duk-Woo Park, Endowed-Chair Professor Seung-Jung Park, and Professor Do-Yoon Kang, along with Clinical Fellow Seong Bong Wee from the Division of Cardiology at Asan Medical Center, analyzed treatment outcomes in 2,018 high risk patients who underwent complex coronary stenting. Patients were divided into a standard therapy group and a personalized therapy group. After one year, the analysis showed no significant difference between the two groups in the incidence of major clinical events, including death, stroke, emergency revascularization, and bleeding.

The results of this study were published in the ‘European Heart Journal’, one of the world’s most prestigious journals in the field with an impact factor of 35.6. They were also presented at the “Hot Line” main session of the European Society of Cardiology (ESC) Congress 2025, the most authoritative academic meeting in cardiology, recently held in Madrid, Spain. The congress drew more than 45,000 participants, marking the largest scale in its history.

Patients are classified as high risk when the narrowed coronary lesions are located in the left main artery or bifurcation, when severe calcification is present, when multiple stents are required for multivessel disease, or when comorbidities such as diabetes or kidney disease are present. These cases involve more complex procedures and carry a higher risk of thrombosis after stent placement.

For such high risk patients, there has been increasing discussion on the need for personalized therapy with intensive drug treatment immediately after the procedure to minimize complications.

The cardiology research team at Asan Medical Center conducted a randomized study involving 2,018 high risk patients who underwent complex coronary stenting. The patients were divided into two groups: 1,005 patients received personalized therapy with high intensity drug treatment for six months after the procedure followed by reduced intensity therapy for the next six months; 1,013 patients received standard therapy with uniform drug treatment at a standard intensity for one year after stent placement. The team then analyzed the treatment outcomes of both groups.

In the personalized therapy group, patients received a combination of ticagrelor and aspirin for six months, followed by clopidogrel alone for the next six months. In contrast, patients in the standard therapy group received a combination of clopidogrel and aspirin for 12 months.

As a result, the incidence of major clinical events, including death, stroke, myocardial infarction, emergency revascularization, and bleeding, was 10.5 percent in the personalized therapy group and 8.8 percent in the standard therapy group, showing no statistically significant difference between the two groups.

A closer analysis revealed that the rates of major ischemic events, such as death, stroke, and stent thrombosis, were 3.9 percent in the personalized therapy group and 5.0 percent in the standard therapy group, with no significant difference. However, the incidence of clinically significant bleeding was 7.2 percent in the personalized therapy group compared to 4.8 percent in the standard therapy group, indicating a statistically significant increase among patients receiving personalized therapy.

▲ Professor Duk-Woo Park (center screen) of the Division of Cardiology at Asan Medical Center delivers a presentation at the main session of the European Society of Cardiology Congress held in Spain on August 31.

Professor Duk-Woo Park from the Division of Cardiology at Asan Medical Center, who presented the study on August 31 at the European Society of Cardiology Congress, stated, “There has been ongoing global debate about the optimal drug therapy for high risk patients undergoing complex coronary stenting. Through this large scale study, we have demonstrated that personalized therapy does not provide clinical advantages over standard therapy.”

He added, “Since evidence regarding the optimal antithrombotic therapy for high risk stent patients is still relatively limited, we will continue our research to ensure that patients with coronary artery disease receive the most effective drug treatments.”