Short-Course Potent P2Y₁₂ Inhibitor-Based DAPT Versus Clopidogrel-Based DAPT After PCI: A Propensity-Matched...

This study aimed to evaluate whether a 1-month course of ticagrelor or prasugrel followed by clopidogrel offers any clinical advantage over clopidogrel-based dual antiplatelet therapy (DAPT) in routine practice.

We conducted a retrospective, propensity-matched cohort study of ACS patients who underwent PCI between 2015 and 2021 at Chiang Rai Prachanukroh Hospital. Patients were grouped by their P2Y₁₂ regimen: 1-month potent P2Y₁₂ inhibitor (ticagrelor or prasugrel) followed by clopidogrel, or continuous clopidogrel-based DAPT. All patients received aspirin. Propensity score matching and Cox regression were used to adjust for confounders. The primary outcome was a composite of thrombotic readmission or all-cause mortality at 1 year. Bleeding-related readmissions were assessed as the safety endpoint.

A total of 1,117 patients were included. After matching, no significant differences were observed in the primary composite outcome across comparisons. In the clopidogrel vs. ticagrelor cohort (n = 161 per group), adjusted hazard ratio (HR) was 1.09 (95% CI: 0.56-2.11; P = 0.808). For clopidogrel vs. prasugrel (n = 139 per group), HR was 0.97 (95% CI: 0.43-2.22; P = 0.945). In the ticagrelor vs. prasugrel cohort (n = 275 per group), HR was 0.62 (95% CI: 0.33-1.17; P = 0.143). LVEF < 40% and residual coronary disease were independently associated with adverse outcomes (HR 4.44 and 8.39, respectively).

A 1-month course of potent P2Y₁₂ inhibitor followed by clopidogrel was not superior to clopidogrel-based DAPT in reducing thrombotic readmission or mortality. Optimizing revascularization and heart failure therapy remains essential in high-risk patients.