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P2Y12 inhibitor monotherapy or dual antiplatelet therapy after coronary revascularisation: individual patient level meta-analysis of randomised controlled trials

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dc.contributor.author김병극-
dc.contributor.author장양수-
dc.contributor.author홍성진-
dc.date.accessioned2022-11-24T00:40:40Z-
dc.date.available2022-11-24T00:40:40Z-
dc.date.issued2021-06-
dc.identifier.issn0959-8138-
dc.identifier.urihttps://ir.ymlib.yonsei.ac.kr/handle/22282913/190889-
dc.description.abstractObjective: To assess the risks and benefits of P2Y12 inhibitor monotherapy compared with dual antiplatelet therapy (DAPT) and whether these associations are modified by patients' characteristics. Design: Individual patient level meta-analysis of randomised controlled trials. Data sources: Searches were conducted in Ovid Medline, Embase, and three websites (www.tctmd.com, www.escardio.org, www.acc.org/cardiosourceplus) from inception to 16 July 2020. The primary authors provided individual participant data. Eligibility criteria: Randomised controlled trials comparing effects of oral P2Y12 monotherapy and DAPT on centrally adjudicated endpoints after coronary revascularisation in patients without an indication for oral anticoagulation. Main outcome measures: The primary outcome was a composite of all cause death, myocardial infarction, and stroke, tested for non-inferiority against a margin of 1.15 for the hazard ratio. The key safety endpoint was Bleeding Academic Research Consortium (BARC) type 3 or type 5 bleeding. Results: The meta-analysis included data from six trials, including 24 096 patients. The primary outcome occurred in 283 (2.95%) patients with P2Y12 inhibitor monotherapy and 315 (3.27%) with DAPT in the per protocol population (hazard ratio 0.93, 95% confidence interval 0.79 to 1.09; P=0.005 for non-inferiority; P=0.38 for superiority; τ2=0.00) and in 303 (2.94%) with P2Y12 inhibitor monotherapy and 338 (3.36%) with DAPT in the intention to treat population (0.90, 0.77 to 1.05; P=0.18 for superiority; τ2=0.00). The treatment effect was consistent across all subgroups, except for sex (P for interaction=0.02), suggesting that P2Y12 inhibitor monotherapy lowers the risk of the primary ischaemic endpoint in women (hazard ratio 0.64, 0.46 to 0.89) but not in men (1.00, 0.83 to 1.19). The risk of bleeding was lower with P2Y12 inhibitor monotherapy than with DAPT (97 (0.89%) v 197 (1.83%); hazard ratio 0.49, 0.39 to 0.63; P<0.001; τ2=0.03), which was consistent across subgroups, except for type of P2Y12 inhibitor (P for interaction=0.02), suggesting greater benefit when a newer P2Y12 inhibitor rather than clopidogrel was part of the DAPT regimen. Conclusions: P2Y12 inhibitor monotherapy was associated with a similar risk of death, myocardial infarction, or stroke, with evidence that this association may be modified by sex, and a lower bleeding risk compared with DAPT. Registration: PROSPERO CRD42020176853.-
dc.description.statementOfResponsibilityopen-
dc.languageEnglish-
dc.publisherBritish Medical Association-
dc.relation.isPartOfBMJ-BRITISH MEDICAL JOURNAL-
dc.rightsCC BY-NC-ND 2.0 KR-
dc.subject.MESHAged-
dc.subject.MESHCoronary Artery Disease / drug therapy*-
dc.subject.MESHCoronary Artery Disease / surgery-
dc.subject.MESHDual Anti-Platelet Therapy / adverse effects*-
dc.subject.MESHDual Anti-Platelet Therapy / methods-
dc.subject.MESHFemale-
dc.subject.MESHHemorrhage / chemically induced-
dc.subject.MESHHemorrhage / epidemiology-
dc.subject.MESHHumans-
dc.subject.MESHMale-
dc.subject.MESHMiddle Aged-
dc.subject.MESHMortality / trends-
dc.subject.MESHMyocardial Infarction / epidemiology-
dc.subject.MESHMyocardial Infarction / prevention & control-
dc.subject.MESHOutcome Assessment, Health Care-
dc.subject.MESHPercutaneous Coronary Intervention / adverse effects*-
dc.subject.MESHPercutaneous Coronary Intervention / mortality-
dc.subject.MESHPercutaneous Coronary Intervention / standards-
dc.subject.MESHPurinergic P2Y Receptor Antagonists / adverse effects*-
dc.subject.MESHPurinergic P2Y Receptor Antagonists / therapeutic use-
dc.subject.MESHRandomized Controlled Trials as Topic-
dc.subject.MESHRisk Assessment-
dc.subject.MESHStroke / epidemiology-
dc.subject.MESHStroke / prevention & control-
dc.subject.MESHThrombosis / drug therapy-
dc.subject.MESHThrombosis / prevention & control-
dc.titleP2Y12 inhibitor monotherapy or dual antiplatelet therapy after coronary revascularisation: individual patient level meta-analysis of randomised controlled trials-
dc.typeArticle-
dc.contributor.collegeCollege of Medicine (의과대학)-
dc.contributor.departmentDept. of Internal Medicine (내과학교실)-
dc.contributor.googleauthorMarco Valgimigli-
dc.contributor.googleauthorFelice Gragnano-
dc.contributor.googleauthorMattia Branca-
dc.contributor.googleauthorAnna Franzone-
dc.contributor.googleauthorUsman Baber-
dc.contributor.googleauthorYangsoo Jang-
dc.contributor.googleauthorTakeshi Kimura-
dc.contributor.googleauthorJoo-Yong Hahn-
dc.contributor.googleauthorQiang Zhao-
dc.contributor.googleauthorStephan Windecker-
dc.contributor.googleauthorCharles M Gibson-
dc.contributor.googleauthorByeong-Keuk Kim-
dc.contributor.googleauthorHirotoshi Watanabe-
dc.contributor.googleauthorYoung Bin Song-
dc.contributor.googleauthorYunpeng Zhu-
dc.contributor.googleauthorPascal Vranckx-
dc.contributor.googleauthorShamir Mehta-
dc.contributor.googleauthorSung-Jin Hong-
dc.contributor.googleauthorKenji Ando-
dc.contributor.googleauthorHyeon-Cheol Gwon-
dc.contributor.googleauthorPatrick W Serruys-
dc.contributor.googleauthorGeorge D Dangas-
dc.contributor.googleauthorEùgene P McFadden-
dc.contributor.googleauthorDominick J Angiolillo-
dc.contributor.googleauthorDik Heg 5-
dc.contributor.googleauthorPeter Jüni-
dc.contributor.googleauthorRoxana Mehran-
dc.identifier.doi10.1136/bmj.n1332-
dc.contributor.localIdA00493-
dc.contributor.localIdA03448-
dc.contributor.localIdA04403-
dc.relation.journalcodeJ00419-
dc.identifier.eissn1756-1833-
dc.identifier.pmid34135011-
dc.identifier.urlhttps://www.bmj.com/content/373/bmj.n1332-
dc.contributor.alternativeNameKim, Byeong Keuk-
dc.contributor.affiliatedAuthor김병극-
dc.contributor.affiliatedAuthor장양수-
dc.contributor.affiliatedAuthor홍성진-
dc.citation.volume373-
dc.citation.startPagen1332-
dc.identifier.bibliographicCitationBMJ-BRITISH MEDICAL JOURNAL, Vol.373 : n1332, 2021-06-
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers

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