Coronary disease & ACSMeta-analysis
P2Y 12 inhibitor or aspirin after percutaneous coronary intervention: individual patient data meta-analysis of randomised clinical trials
- Individual participant data meta-analysis of randomised clinical trials
- one stage and two stage analyses
Authors' conclusion
In patients who had undergone PCI and discontinued DAPT, at a follow-up of about 5.5 years, P2Y12 inhibitor monotherapy with ticagrelor or clopidogrel was associated with lower MACCE, owing to reduced rates of myocardial infarction and stroke compared with aspirin monotherapy, without a concurrent increased risk of major bleeding.
Study context
- Population
- Patients with CAD after percutaneous coronary intervention (PCI) and completion of the recommended DAPT regimen (median 12 months)
- Participants
- 16,117 patients · 5 RCTs
- Comparison
- P2Y12 inhibitor vs Aspirin
- Outcome
- MACCE (primary) and major bleeding (co-primary)
- Follow-up
- Median 1351 days (IQR 373-1791)
Pooled result
As reported in the abstract
MACCE (primary); major bleeding (co-primary) · median follow-up 1351 days (IQR 373-1791 days)
P2Y12 inhibitor vs AspirinEstimateP value
MACCE, one stage analysis; NNT 45.5 (95% CI 31.4 to 93.6)
HR 0.77(95% CI 0.67–0.89)
P < 0.001MACCE, multivariable one stage analysis
adjusted HR 0.77(CI 0.67–0.89)
P < 0.001- No significant difference in major bleeding, one stage analysis: HR 1.26 (0.78 to 2.04)
- P = 0.35
- No significant difference in major bleeding, multivariable one stage analysis: 1.12 (0.74 to 1.70)
- P = 0.60
- No significant difference in major bleeding, two stage analysis: 1.15 (0.69 to 1.92)
- P = 0.59
Further pooled results
NACCE, MI, stroke
- Lower with P2Y12 inhibitor vs aspirin
Safety
Major bleeding
- No significant difference (one stage HR 1.26, 0.78 to 2.04)
- P = 0.35
Original publication
P2Y 12 inhibitor or aspirin after percutaneous coronary intervention: individual patient data meta-analysis of randomised clinical trials. BMJ. Published 4 June 2025. doi:10.1136/bmj-2024-082561
Summarised from the published abstract; every number is checked against it