Study Title: TAILORED-CHIP: Tailored antiplatelet therapy for complex high-risk PCI

Presented at: ESC Congress 2025

Link: https://esc365.escardio.org/presentation/312209

Prepared by: Dr. Yusuf Uyanık, Dr. Mustafa Yenerçağ

Introduction:
In patients undergoing complex and high ischemic risk percutaneous coronary intervention (PCI), dual antiplatelet therapy (DAPT) reduces ischemic events but increases the risk of bleeding. Previous studies have mainly focused on bleeding reduction strategies in high bleeding risk patients. However, the optimal antiplatelet strategy for patients with high ischemic risk undergoing complex PCI remains uncertain.

Objective:
The aim of the TAILORED-CHIP trial was to evaluate the efficacy and safety of time-dependent modulation of antiplatelet therapy (early escalation, late de-escalation) compared with standard 12-month DAPT in patients undergoing complex PCI at high ischemic risk.

Methods:
This randomized controlled trial was conducted across 24 centers in South Korea and included a total of 2,018 patients. Inclusion criteria were anatomical factors such as left main PCI, complex bifurcation, chronic total occlusion, multivessel or long lesions, and clinical factors such as diabetes, chronic kidney disease, or left ventricular ejection fraction <40%.
Tailored strategy: Ticagrelor + aspirin for the first 6 months, followed by clopidogrel monotherapy for the next 6 months.
Control group: Standard DAPT with aspirin + clopidogrel for 12 months.
The primary endpoint was the incidence of net adverse clinical events (NACE) at 12 months, defined as a composite of death, myocardial infarction (MI), stroke, stent thrombosis, urgent revascularization, or clinically relevant bleeding.

Results:
The mean age of patients was 64 years, and 83% were male. The incidence of NACE was 10.5% in the tailored group versus 8.8% in the control group (HR 1.19; p=0.21). Rates of major ischemic events were similar between groups (3.9% vs 5.0%; p=0.25). Hard clinical endpoints were numerically lower in the tailored group but did not reach statistical significance (3.3% vs 4.9%; p=0.08). Clinically relevant bleeding was higher in the tailored group (7.2% vs 4.8%; p=0.002), while no difference was observed in major bleeding events.

Conclusions:
The TAILORED-CHIP trial demonstrated that time-dependent modulation of antiplatelet therapy was not superior to standard 12-month DAPT. Early escalation increased bleeding risk, whereas ischemic benefit was limited.

Commentary:
The findings support the safety of clopidogrel monotherapy after 6 months. However, the increased bleeding burden during the early escalation phase reduced the overall clinical benefit of the tailored strategy. Based on current evidence, the ESC guideline recommendation of 6 months of aspirin + clopidogrel remains the most appropriate approach. Future studies should investigate whether shorter periods of intensified therapy may provide a better balance between ischemic protection and bleeding risk.