Does P2Y12 inhibitor monotherapy reduce MACCE and major bleeding compared to aspirin monotherapy in patients after PCI and discontinuation of DAPT?
In patients post-PCI discontinuing DAPT, P2Y12 inhibitor monotherapy reduces MACCE compared to aspirin without increasing major bleeding.
OBJECTIVE: inhibitor monotherapy compared with aspirin monotherapy in patients after percutaneous coronary intervention (PCI) and discontinuation of dual antiplatelet therapy (DAPT). DESIGN: Individual participant data (IPD) meta-analysis of randomised clinical trials. DATA SOURCES: PubMed/Medline, Scopus, Web of Science, and Ovid/Embase. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: inhibitor or aspirin for secondary prevention of ischaemic events in patients with coronary artery disease who underwent PCI. DATA EXTRACTION AND SYNTHESIS: Anonymised IPD were extracted and transferred to the coordinating centre by dedicated electronic spreadsheets. Data were primarily combined by mixed effects models (one stage analysis) and complemented with multivariable mixed effects models and two stage analyses based on random effects models. The primary and co-primary outcomes were a composite of major adverse cardiac and cerebrovascular events (MACCE) and major bleeding, respectively. The secondary outcomes included a net composite of adverse cardiac and cerebrovascular events (NACCE), derived from the combination of the primary and co-primary outcomes, and individual ischaemic and bleeding events. RESULTS: inhibitor compared with those assigned to aspirin. These findings were confirmed across multiple sensitivity and subgroup analyses. CONCLUSIONS: inhibitor monotherapy with ticagrelor or clopidogrel was associated with lower MACCE, owing to reduced rates of myocardial infarction and stroke compared with aspirin monotherapy, without a concurrent increased risk of major bleeding. REVIEW REGISTRATION: PROSPERO CRD42024517983.
Giacoppo et al. (Wed,) studied this question.