P2Y₁₂ Inhibitor Monotherapy or Dual Antiplatelet Therapy After Complex Percutaneous Coronary Interventions.

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Pharmacology

Background:

• The optimal antiplatelet strategy post-complex percutaneous coronary intervention (PCI) remains debated, balancing ischemic event prevention with bleeding risk.
• Dual antiplatelet therapy (DAPT) is standard, but P2Y12 inhibitor monotherapy is being explored as a potentially safer alternative.

Approach:

• A meta-analysis of patient-level data from randomized controlled trials comparing P2Y12 inhibitor monotherapy with standard DAPT after coronary revascularization.
• Complex PCI was defined by specific criteria including number of vessels treated, stents implanted, lesions treated, bifurcation stenting, total stent length, and chronic total occlusion.
• Primary efficacy endpoint: all-cause mortality, myocardial infarction, and stroke. Key safety endpoint: Bleeding Academic Research Consortium (BARC) 3 or 5 bleeding.

Key Points:

• In complex PCI patients, P2Y12 inhibitor monotherapy demonstrated similar rates of the primary efficacy endpoint (mortality, MI, stroke) compared to DAPT.
• P2Y12 inhibitor monotherapy significantly reduced major bleeding events (BARC 3 or 5) compared to DAPT in both complex and non-complex PCI.
• Treatment effects were consistent across all components defining complex PCI, indicating broad applicability.

Conclusions:

• P2Y12 inhibitor monotherapy following 1-3 months of DAPT offers comparable ischemic protection to standard DAPT after PCI.
• This strategy significantly lowers the risk of major bleeding, regardless of PCI complexity.
• The findings support P2Y12 inhibitor monotherapy as a viable option to reduce bleeding complications post-PCI without compromising efficacy.