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P2Y12 Inhibitor or Aspirin Monotherapy for Chronic Coronary Disease: A Nationwide Cohort Study

Minyoul Baik1, Jimin Jeon1, Joonsang Yoo1

  • 1Department of Neurology, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin-si, Gyeonggi-do, Republic of Korea, yonsei.ac.kr.

Cardiovascular Therapeutics
|December 24, 2025
PubMed

Insights

P2Y12 inhibitor monotherapy showed similar outcomes to aspirin monotherapy in chronic coronary disease patients. However, P2Y12 inhibitors may reduce major gastrointestinal bleeding events, supporting guideline recommendations.

Area of Science:

  • Cardiology
  • Pharmacology
  • Clinical Research

Background:

  • The 2024 European Society of Cardiology (ESC) guideline suggests clopidogrel as an alternative to aspirin monotherapy for chronic coronary disease (CAD).
  • This study aimed to validate this recommendation by comparing P2Y12 inhibitor monotherapy with aspirin monotherapy in CAD patients.

Purpose of the Study:

  • To compare the long-term prognosis of patients with chronic CAD on P2Y12 inhibitor monotherapy versus aspirin monotherapy.
  • To assess the safety and efficacy of P2Y12 inhibitor monotherapy in a real-world setting.

Main Methods:

  • Retrospective cohort study using a Korean nationwide health claims database.
  • Included patients with chronic CAD 18 months post-percutaneous coronary intervention (PCI) with drug-eluting stents (DES).
  • 1:1 propensity score matching was used to compare P2Y12 inhibitor monotherapy and aspirin monotherapy groups, analyzing a composite outcome of death, myocardial infarction, ischemic stroke, and major bleeding.

Main Results:

  • P2Y12 inhibitor monotherapy (n=42,692) showed comparable outcomes to aspirin monotherapy (n=42,692) regarding the primary composite outcome (HR: 0.98; 95% CI: 0.92-1.05).
  • Secondary analyses revealed a trend towards reduced major bleeding with P2Y12 inhibitors (HR: 0.86; 95% CI: 0.72-1.02).
  • A significant reduction in major gastrointestinal bleeding was observed with P2Y12 inhibitors (HR: 0.79; 95% CI: 0.63-0.97; p=0.027).

Conclusions:

  • P2Y12 inhibitor monotherapy is comparable to aspirin monotherapy in long-term outcomes for Korean patients with chronic CAD after DES PCI.
  • P2Y12 inhibitor monotherapy may offer a potential advantage in reducing gastrointestinal bleeding.
  • Findings support the feasibility of P2Y12 inhibitor monotherapy, aligning with 2024 ESC guidelines, but further prospective studies are needed.
Abstract

Keywords:
aspirinchronic coronary diseasep2y12 inhibitorpercutaneous coronary intervention

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