Coronary disease & ACSMeta-analysis
P2Y12 Inhibitor or Aspirin Monotherapy for Secondary Prevention of Coronary Events
- Individual patient data meta-analysis of randomised trials
- patient-level
- 1-step meta-analysis
Authors' conclusion
Given its superior efficacy and similar overall safety, P2Y12 inhibitor monotherapy might be preferred over aspirin monotherapy for long-term secondary prevention in patients with established CAD.
Study context
- Population
- Patients with established coronary artery disease (CAD)
- Participants
- 24,325 patients · 7 trials
- Comparison
- P2Y12 inhibitor monotherapy vs aspirin monotherapy
- P2Y12 inhibitorn = 12,178
- Aspirinn = 12,147reference
- Outcome
- CV death, MI and stroke
- Follow-up
- 2 years
Pooled result
As reported in the abstract
Hazard ratio
0.88
95% CI 0.79–0.97
P = 0.012
P2Y12 inhibitor vs Aspirin
HR 0.88 (95% CI 0.79–0.97); P = 0.012
Further pooled results
| Outcome | HR (95% CI) | P value | |
|---|---|---|---|
| MI | 0.77 (0.66–0.90) | P < 0.001 | |
| Net adverse clinical events (primary outcome and major bleeding) | 0.89 (0.81–0.98) | P = 0.020 | |
| 0.512Hazard ratio (log scale) |
Prespecified subgroups and types of P2Y12 inhibitors
- Treatment effect consistent across prespecified subgroups and types of P2Y12 inhibitors
Safety
| Outcome | HR (95% CI) | P value | |
|---|---|---|---|
| Major bleeding · similar | 0.87 (0.70–1.09) | P = 0.23 | |
| 0.512Hazard ratio (log scale) |
Original publication
P2Y12 Inhibitor or Aspirin Monotherapy for Secondary Prevention of Coronary Events. J Am Coll Cardiol. Published 11 July 2023. doi:10.1016/j.jacc.2023.04.051
Summarised from the published abstract; every number is checked against it