Key result
PCI complexity does not modify the efficacy or safety of P2Y12 monotherapy versus DAPT.
Why the study?
It was unknown whether the anatomical complexity of PCI in ACS influences the effects of antiplatelet therapy.
Does P2Y12 inhibitor monotherapy improve ischemic or bleeding outcomes compared to DAPT in patients with ACS undergoing complex PCI?
RCT (n=3,408)
randomised
Does P2Y12 inhibitor monotherapy improve ischemic or bleeding outcomes compared to DAPT in patients with ACS undergoing complex PCI?
p-value: p=0.68
P2Y12 inhibitor monotherapy provides similar ischemic and bleeding outcomes compared to DAPT in ACS patients, regardless of PCI complexity.
P2Y12 monotherapy yields similar ischemic and bleeding outcomes to DAPT in complex PCI; extends trial findings across PCI complexity.
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Prado et al. (2026) conducted an RCT in acute coronary syndromes (n=3,408). ticagrelor- or prasugrel-based monotherapy vs. dual antiplatelet therapy (DAPT) was evaluated on Coprimary endpoints: (i) composite of death, myocardial infarction, urgent target vessel revascularisation, or stroke; and (ii) BARC Type 2, 3, or 5 bleeding (p=0.68). PCI complexity did not significantly modify the treatment effects of P2Y12 inhibitor monotherapy versus DAPT on the ischaemic coprimary endpoint (p-interaction=0.68) or bleeding outcomes.
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