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Efficacy and safety of P2Y12 inhibitor monotherapy after complex PCI: a collaborative systematic review and meta-analysis

Authors
 Johny Nicolas  ;  George Dangas  ;  Mauro Chiarito  ;  Carlo A Pivato  ;  Alessandro Spirito  ;  Davide Cao  ;  Gennaro Giustino  ;  Frans Beerkens  ;  Anton Camaj  ;  Birgit Vogel  ;  Samantha Sartori  ;  Ko Yamamoto  ;  Takeshi Kimura  ;  Byeong-Keuk Kim  ;  Usman Baber  ;  Roxana Mehran 
Citation
 EUROPEAN HEART JOURNAL-CARDIOVASCULAR PHARMACOTHERAPY, Vol.9(3) : 240-250, 2023-04 
Journal Title
EUROPEAN HEART JOURNAL-CARDIOVASCULAR PHARMACOTHERAPY
ISSN
 2055-6837 
Issue Date
2023-04
MeSH
Aspirin / adverse effects ; Hemorrhage / chemically induced ; Humans ; Myocardial Infarction* / therapy ; Percutaneous Coronary Intervention* / adverse effects ; Percutaneous Coronary Intervention* / methods ; Platelet Aggregation Inhibitors / adverse effects ; Purinergic P2Y Receptor Antagonists / adverse effects ; Randomized Controlled Trials as Topic
Keywords
Antiplatelet therapy ; Aspirin ; Complex percutaneous coronary intervention ; Drug-eluting stent
Abstract
Aims: Complex percutaneous coronary intervention (C-PCI) is associated with an increased risk of ischaemic and bleeding complications. We aimed to assess the safety and efficacy of a 1-3-month dual antiplatelet therapy (DAPT) regimen followed by P2Y12 inhibitor monotherapy after C-PCI.

Methods and results: We conducted a meta-analysis of randomized trials comparing a 1-3-month DAPT regimen followed by P2Y12 inhibitor monotherapy with standard (≥12 months) DAPT in patients undergoing C-PCI. C-PCI criteria and the co-primary bleeding and ischaemic outcomes were determined according to each trial. Secondary outcomes included major bleeding, all-cause death, myocardial infarction, and stent thrombosis. All outcomes were evaluated at 12 months after randomization. We used hazard ratios (HRs) and 95% confidence interval (CI) as a metric of choice for treatment effects with random-effects models. Among 8299 screened studies, five randomized trials fulfilled the eligibility criteria. In the pooled population of 34 615 patients, 8818 (25.5%) underwent C-PCI. As compared with standard DAPT, a 1-3-month DAPT regimen followed by P2Y12 inhibitor monotherapy reduced the bleeding risk in C-PCI (HR:0.66, 95% CI:0.44-0.98) and non-C-PCI (HR:0.60, 95% CI:0.45-0.79) patients (P-interaction = 0.735). Furthermore, the risk for the primary ischaemic endpoint was similar in patients randomized to either arm, with significant effect modification by PCI complexity showing an enhanced benefit of 1-3-month DAPT in patients undergoing C-PCI (C-PCI, HR:0.69, 95% CI:0.48-1.00; non-C-PCI, HR:1.04, 95% CI:0.84-1.30; P-interaction = 0.028).

Conclusion: As compared with a standard DAPT, a 1-3-month DAPT regimen followed by P2Y12 inhibitor monotherapy reduced bleeding complications after C-PCI without increasing the risk of ischaemic events.PROSPERO-registered (CRD42021259271).
Full Text
https://academic.oup.com/ehjcvp/article-abstract/9/3/240/6958797
DOI
10.1093/ehjcvp/pvac071
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Byeong Keuk(김병극) ORCID logo https://orcid.org/0000-0003-2493-066X
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/198741
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