Key result
P2Y12 inhibitor monotherapy reduces MACE ~30% versus aspirin following DAPT in post-PCI patients.
Why the study?
It remains controversial which antiplatelet monotherapy should be continued after a period of DAPT in post-PCI patients.
Does P2Y12 inhibitor monotherapy reduce major adverse cardiovascular events in post-PCI patients after completing DAPT compared to aspirin monotherapy?
Meta-Analysis (n=24,460)
Yes
Does P2Y12 inhibitor monotherapy reduce major adverse cardiovascular events in post-PCI patients after completing DAPT compared to aspirin monotherapy?
In post-PCI patients completing DAPT, P2Y12 inhibitor monotherapy significantly reduces MACE, repeat revascularization, and stroke compared to aspirin monotherapy, without increasing overall major bleeding risk.
Supports P2Y12 monotherapy after DAPT in post-PCI patients; confirms MACE reduction versus aspirin without excess major bleeding.
Background: With the publication of a large number of clinical studies on antiplatelet therapy in recent years, it is still controversial which antiplatelet monotherapy should be continued after a period of dual antiplatelet therapy (DAPT) in the post percutaneous coronary intervention (post-PCI) population. We conducted a meta-analysis to investigate the efficacy and safety of P2Y12 inhibitors versus aspirin in the post-PCI population after completing DAPT. Methods: We searched studies in electronic databases from January 1, 2015 to November 20, 2022. We conducted a meta-analysis to estimate the effect of P2Y12 inhibitor monotherapy on clinical end-points in post-PCI patients after a period of DAPT, using trial-level data with consistent end-point definitions. The primary outcome was major adverse cardiovascular events (MACE). Odd ratio (OR) was pooled with 95% confidence interval (CI) for dichotomous data. This study is registered with INPLASY 2022120011. Results: We included five studies that included 24,460 patients. The patients who received a P2Y12 inhibitor showed a lower risk of MACE than patients who received aspirin (OR 0.70 [95% CI 0.60–0.80], I2 = 0%, p < 0.00001) monotherapy. Subgroup analysis of MACE based on patient characteristics showed consistent results with the main analysis. The risk of major bleeding was similar in patients who received a P2Y12 inhibitor and those who received aspirin (OR 0.86 [95% CI 0.53–1.39], I2 = 57%, p = 0.54). The risk of major bleeding was borderline increased in patients who received ticagrelor versus aspirin (OR 1.81 [95% CI 0.99–3.31], p = 0.05). Conclusions: In the post-PCI population, P2Y12 inhibitor monotherapy may be superior to aspirin for MACE, repeat revascularization, and stroke without increasing the risk of major bleeding.
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Gao et al. (2023) conducted a meta-analysis in Ischemic heart disease post-percutaneous coronary intervention (PCI) (n=24,460). P2Y12 inhibitor monotherapy vs. Aspirin monotherapy was evaluated on Major adverse cardiovascular events (MACE) (OR 0.70, 95% CI 0.60-0.80, p=<0.00001). P2Y12 inhibitor monotherapy significantly reduced the risk of major adverse cardiovascular events compared to aspirin monotherapy in post-PCI patients following dual antiplatelet therapy (OR 0.70).
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