P2Y12 inhibitor monotherapy on par with DAPT after complex PCI

Compared with standard dual antiplatelet therapy (DAPT), P2Y₁₂ inhibitor monotherapy after 1- to 3-month DAPT results in similar rates of fatal and ischaemic events, as well as lower major bleeding risk, regardless of percutaneous coronary intervention (PCI) complexity, according to a study.

The authors pooled patient-level data from randomized controlled trials that compared P2Y₁₂ inhibitor monotherapy with standard DAPT on centrally adjudicated outcomes after coronary revascularization. They defined complex PCI as any of the following: 3 vessels treated, ≥3 stents implanted, ≥3 lesions treated, bifurcation with two stents implanted, total stent length >60 mm, or chronic total occlusion.

All-cause mortality, myocardial infarction, and stroke were the primary efficacy endpoints, while the key safety endpoint was Bleeding Academic Research Consortium (BARC) 3 or 5 bleeding.

A total of 22,941 patients undergoing PCI from five trials were included in the study, of whom 4,685 (20.4 percent) with complex PCI had higher rates of ischaemic events.

P2Y₁₂ inhibitor monotherapy and DAPT resulted in similar efficacy endpoints among patients with complex PCI (hazard ratio [HR], 0.87, 95 percent confidence interval [CI], 0.64‒1.19) and noncomplex PCI (HR, 0.91, 95 percent CI, 0.76‒1.09; p_interaction=0.770). Notably, the treatment effect persisted across all components of the complex PCI definition.

In terms of safety, P2Y₁₂ inhibitor monotherapy compared with DAPT resulted in a consistent reduction of BARC 3 or 5 bleeding in complex PCI (HR, 0.51, 95 percent CI, 0.31‒0.84) and noncomplex PCI patients (HR, 0.49, 95 percent CI, 0.37‒0.64; p_interaction=0.920).