Aspirin or P2Y12 Inhibitor Monotherapy After Percutaneous Coronary Intervention for Acute Coronary Syndromes
Claudio Laudani, Daniele Giacoppo, Giovanni Occhipinti, Mattía Galli, Antonio Greco, Marco Spagnolo, Luis Ortega‐Paz, Francesco Costa, Dominick J Angiolillo, Davide Capodanno
Abstract
BACKGROUND: inhibitor monotherapy is debated. OBJECTIVES: inhibitor monotherapy after short DAPT. METHODS: Randomized trials of short DAPT in ACS patients undergoing PCI were identified. The primary outcome was trial-defined net adverse clinical events (NACE), a composite of ischemic and bleeding events. Secondary outcomes included single components of the primary endpoint. Pairwise and network meta-analyses were conducted. Heterogeneity sources were explored through sensitivity analyses. RESULTS: inhibitor monotherapy reduced NACE (IRR: 0.77; 95% CI: 0.62-0.95) and any bleeding (IRR: 0.68; 95% CI: 0.48-0.95) compared with aspirin monotherapy. Differences for bleeding endpoints, but not NACE, were mitigated when accounting for DAPT duration. CONCLUSIONS: inhibitor monotherapy significantly reducing NACE, any bleeding, and major bleeding, whereas aspirin monotherapy had neutral results. (Dual Antiplatelet Therapy De-Escalation Followed By Aspirin or P2Y12 Inhibitor Monotherapy after Percutaneous Coronary Intervention for Acute Coronary Syndrome: a Systematic Review and Meta-analysis; CRD42025645844).