Weekly Journal Scan: can an individual participant data meta-analysis support a practice change in long-term antiplatelet therapy after percutaneous coronary intervention?

This comment refers to ‘P2Y12 inhibitor or aspirin after percutaneous coronary intervention: individual patient data meta-analysis of randomised clinical trials’ published in the British Medical Journal, http://doi.org/10.1136/bmj-2024-082561. Over the past four decades, aspirin has been unanimously considered the cornerstone of secondary prevention in patients with coronary artery disease (CAD), supported by a large number of randomized controlled trials (RCTs) vs placebo.4 Thirty years ago, the CAPRIE trial evaluated clopidogrel vs aspirin (325 mg daily) in 19 185 patients with atherosclerotic cardiovascular (CV) disease (ASCVD) from non-Asian countries, stratified by clinical centre and the three vascular disease (coronary, cerebrovascular, and peripheral) categories.5 Although clopidogrel modestly reduced major adverse cardiovascular events (MACE) in the overall population [relative risk reduction, 8.7%; 95% confidence interval (CI), 0.3–16.5; P = .043], there was statistically significant heterogeneity in treatment effects across the three clinical presentations of ASCVD, with no benefit in the group of 6302 post-myocardial infarction (MI) patients (in fact, with a numerical trend in the opposite direction), thus reinforcing the role of aspirin as the standard antiplatelet therapy for secondary prevention in CAD patients.5