Risk for major adverse cardiac and cerebrovascular events lower compared with aspirin monotherapy for patients who undergo PCI and discontinue DAPT
By Elana Gotkine HealthDay Reporter
FRIDAY, June 6, 2025 (HealthDay News) — For patients who undergo percutaneous coronary intervention (PCI) and discontinue dual antiplatelet therapy (DAPT), P2Y12 inhibitor monotherapy is associated with a lower risk for major adverse cardiac and cerebrovascular events (MACCE) compared with aspirin, according to a meta-analysis published online June 4 in The BMJ.
Daniele Giacoppo, M.D., Ph.D., from the University of Catania in Italy, and colleagues examined the long-term comparative effectiveness of P2Y12 inhibitor monotherapy versus aspirin monotherapy in patients with PCI and discontinuation of DAPT in an individual participant data meta-analysis of randomized clinical trials. Five randomized trials that included 16,117 patients assigned to P2Y12 inhibitor or aspirin monotherapy after PCI and completion of the recommended DAPT regimen were included.
The researchers found that at a median follow-up of 1,351 days, P2Y12 inhibitor monotherapy was associated with a lower risk for MACCE versus aspirin monotherapy (one-stage analysis: hazard ratio, 0.77; multivariable one-stage analysis: adjusted hazard ratio, 0.77; two-stage analysis: hazard ratio, 0.77), yielding a number needed to treat to benefit of 45.5. There was no significant difference seen in major bleeding. Compared with those assigned to aspirin, patients assigned to a P2Y12 inhibitor had a lower net composite of adverse cardiac and cerebrovascular events, myocardial infarction, and stroke. Across multiple sensitivity and subgroup analyses, these findings were confirmed.
“Our data add to previous findings because this is the first meta-analysis including exclusively patients who underwent PCI, providing long term follow-up information and relying on individual participant data from all available PCI trials with contemporary P2Y12 inhibitors,” the authors write.
Several authors disclosed ties to the pharmaceutical industry.
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