Key result
P2Y12 inhibitor monotherapy cuts MACE ~27% versus aspirin monotherapy following DAPT in PCI patients.
Why the study?
P2Y12 inhibitor monotherapy has emerged as a potential alternative to aspirin after DAPT in patients undergoing PCI, but the optimal choice remains uncertain.
Does P2Y12 inhibitor monotherapy reduce major adverse cardiovascular events compared to aspirin monotherapy in patients who have completed dual antiplatelet therapy following percutaneous coronary intervention?
Meta-Analysis (n=29,756)
Does P2Y12 inhibitor monotherapy reduce major adverse cardiovascular events compared to aspirin monotherapy in patients who have completed dual antiplatelet therapy following percutaneous coronary intervention?
P2Y12 inhibitor monotherapy following DAPT post-PCI significantly reduces MACE, repeat revascularization, and stroke compared to aspirin monotherapy, without increasing major bleeding.
Supports P2Y12 monotherapy after DAPT to reduce MACE versus aspirin post-PCI; extends pooled RCT evidence.
Introduction P2Y12 inhibitor monotherapy has emerged as a potential alternative to aspirin following dual antiplatelet therapy (DAPT) in patients undergoing percutaneous coronary intervention (PCI), but the optimal choice remains uncertain. Methods A systematic literature search compared P2Y12 inhibitors with aspirin post PCI. A random-effects model pooled odds ratios (ORs) with 95% confidence intervals (CIs) for outcomes. Results Seven studies (29,756 patients) were included. P2Y12 inhibitors significantly reduced MACE compared to aspirin [OR = 0.73; 95% CI: 0.64–0.84]. No significant difference was observed in all-cause mortality [OR = 0.90; 95% CI: 0.77–1.05], cardiac death [OR = 0.86; 95% CI: 0.68–1.09], major bleeding [OR = 1.06; 95% CI: 0.67–1.68], MI [OR = 0.78; 95% CI: 0.56–1.08], or stent thrombosis [OR = 0.71; 95% CI: 0.41–1.22]. P2Y12 inhibitors significantly reduced repeat revascularisation [OR = 0.83; 95% CI: 0.73–0.94] and stroke [OR = 0.63; 95% CI: 0.48–0.81]. Conclusions P2Y12 inhibitors may be a safer, more effective alternative to aspirin alone after PCI.
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Kazmi et al. (2026) conducted a meta-analysis in Ischaemic heart disease post-percutaneous coronary intervention (n=29,756). P2Y12 inhibitor monotherapy (clopidogrel or ticagrelor) vs. Aspirin monotherapy was evaluated on Major adverse cardiovascular events (MACE) (OR 0.73, 95% CI 0.64-0.84, p=<0.0001). P2Y12 inhibitor monotherapy significantly reduced major adverse cardiovascular events (OR 0.73) compared to aspirin monotherapy following dual antiplatelet therapy in patients after percutaneous coronary intervention.
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