P2Y12 Inhibitors Monotherapy in Patients Undergoing Complex vs Non-Complex Percutaneous Coronary Intervention: A
Angelo Oliva1, Domenico S Castiello2, Anna Franzone2
1Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; Cardio Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy.
American Heart Journal
|October 11, 2022
Summary
P2Y12 inhibitor (P2Y12i) monotherapy after short dual antiplatelet therapy (DAPT) is a safe alternative to standard DAPT, especially for complex percutaneous coronary intervention (PCI) patients. This strategy reduces bleeding risk without increasing thrombotic events.
Area of Science:
- Cardiology
- Interventional Cardiology
- Pharmacology
Background:
- P2Y12 inhibitor (P2Y12i) monotherapy is an emerging alternative to dual antiplatelet therapy (DAPT) post-percutaneous coronary intervention (PCI).
- Concerns exist regarding aspirin withdrawal in P2Y12i monotherapy for high-risk patients, particularly those with complex PCI.
- This study evaluates P2Y12i monotherapy versus standard DAPT based on PCI complexity.
Approach:
- A meta-analysis of randomized trials was conducted using random effects models.
- Hazard ratios (HRs) and 95% confidence intervals (CIs) were pooled.
- Within-trial interactions were analyzed to assess heterogeneity between complex and noncomplex PCI groups.
Key Points:
- P2Y12i monotherapy showed similar risks for all-cause death, stent thrombosis, and stroke compared to standard DAPT.
- A significant reduction in myocardial infarction risk was observed with P2Y12i monotherapy in complex PCI patients (HR 0.77, 95%CI 0.60-0.99).
- Major bleeding risk was significantly reduced with P2Y12i monotherapy in both complex and noncomplex PCI groups.
Conclusions:
- P2Y12i monotherapy following a short DAPT course appears beneficial for patients undergoing complex PCI.
- This strategy may offer improved efficacy and safety compared to standard DAPT in this patient subgroup.
- Early aspirin withdrawal in P2Y12i monotherapy is a viable option, particularly for complex PCI cases.
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