Effect of P2Y12 Inhibitor Monotherapy vs Dual Antiplatelet Therapy on Cardiovascular Events in Patients Undergoing Percutaneous Coronary Intervention
Why the study?
Data on P2Y12 inhibitor monotherapy after short-duration dual antiplatelet therapy in patients undergoing percutaneous coronary intervention were limited.
Does P2Y12 inhibitor monotherapy after 3 months of DAPT compared with 12 months of DAPT prevent major adverse cardiac and cerebrovascular events in patients undergoing PCI with drug-eluting stents?
Population
2993 patients undergoing PCI with drug-eluting stents in Korea
Comparison
P2Y12 inhibitor monotherapy after 3 months DAPT vs 12 months DAPT
Design
Multicenter open-label noninferiority randomized trial
Follow-up
12 months
Authors
Discussion
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Member takes
Implication
Supports shorter DAPT post-PCI without excess ischemic events; extends evidence for P2Y12 monotherapy de-escalation strategies.
Structured PICO
Does P2Y12 inhibitor monotherapy after 3 months of DAPT compared with 12 months of DAPT prevent major adverse cardiac and cerebrovascular events in patients undergoing PCI with drug-eluting stents?
P
Population
2993 patients undergoing percutaneous coronary intervention (PCI) with drug-eluting stents, mean age 64 years, 26.6% women, across 33 hospitals in Korea.
I
Intervention
Aspirin plus a P2Y12 inhibitor for 3 months, followed by P2Y12 inhibitor monotherapy up to 12 months.
C
Comparator
Dual antiplatelet therapy (DAPT) for 12 months.
O
Outcome
Major adverse cardiac and cerebrovascular events (a composite of all-cause death, myocardial infarction, or stroke) at 12 months after the index procedure.composite
In patients undergoing PCI with drug-eluting stents, dropping aspirin after 3 months to continue P2Y12 inhibitor monotherapy is noninferior to 12 months of DAPT for ischemic events and significantly reduces bleeding.
Limitations
- limitations in the study population
- limitations in adherence (79.3% in the P2Y12 inhibitor monotherapy group vs 95.2% in the DAPT group)
Cite This Study
Hahn et al. (2019) studied this question.