Coronary disease & ACSMeta-analysis
Aspirin or P2Y12 Inhibitor Monotherapy After Percutaneous Coronary Intervention for Acute Coronary Syndromes
- Systematic review and network meta-analysis of randomised trials
- pairwise and network meta-analyses
- sensitivity analyses
Median dual antiplatelet therapy (DAPT) duration 4.8 (3.0-6.0) months in aspirin and 2.2 (1.0-3.0) months in P2Y12 inhibitor monotherapy trials
Authors' conclusion
In patients with ACS undergoing PCI, the benefits of short DAPT varied according to the subsequent monotherapy administered, with P2Y12 inhibitor monotherapy significantly reducing NACE, any bleeding, and major bleeding, whereas aspirin monotherapy had neutral results.
Study context
- Population
- Acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI) in randomised trials of short DAPT
- Participants
- 45,394 patients · 23 studies
- Comparison
- P2Y12 inhibitor monotherapy vs aspirin monotherapy after short DAPT
- Outcome
- Trial-defined net adverse clinical events (NACE), composite of ischemic and bleeding events
Pooled result
As reported in the abstract
NACE
P2Y12 inhibitor monotherapy vs Aspirin monotherapyIncidence rate ratio (95% CI)
indirect comparison
0.77(0.62–0.95)
reduced by P2Y12 inhibitor, not aspirin monotherapy
0.78(0.64–0.95)
Further pooled results
Effect of DAPT duration adjustment
- Differences for bleeding endpoints, but not net adverse clinical events (NACE), mitigated when accounting for DAPT duration
Safety
| Outcome | IRR (95% CI) | |
|---|---|---|
| Any bleeding — P2Y12 inhibitor monotherapy vs Aspirin monotherapy · indirect comparison | 0.68 (0.48–0.95) | |
| Any bleeding — P2Y12 inhibitor monotherapy vs Aspirin monotherapy · reduced by P2Y12 inhibitor, not aspirin monotherapy | 0.56 (0.46–0.67) | |
| 0.512Incidence rate ratio (log scale) |
- Any bleeding: interaction between monotherapies Pint = 0.008
Original publication
Aspirin or P2Y12 Inhibitor Monotherapy After Percutaneous Coronary Intervention for Acute Coronary Syndromes. JACC Cardiovasc Interv. Published 11 August 2025. doi:10.1016/j.jcin.2025.05.044
Summarised from the published abstract; every number is checked against it