Article Impact Level: HIGH Data Quality: STRONG Summary of Journal of the American College of Cardiology, 82(2), 89–105. https://doi.org/10.1016/j.jacc.2023.04.051 Dr. Felice Gragnano et al.
Points
- A study compared P2Y12 inhibitor monotherapy with aspirin in patients with established coronary artery disease (CAD).
- P2Y12 inhibitor monotherapy showed a lower risk of cardiovascular death, myocardial infarction, and stroke than aspirin monotherapy.
- The benefit of P2Y12 inhibitor monotherapy was primarily attributed to reducing myocardial infarction risk.
- Significant bleeding risks were similar between the two treatments, but net adverse clinical events were lower with P2Y12 inhibitors.
- The study suggests that P2Y12 inhibitor monotherapy may be a preferred long-term secondary prevention strategy for patients with established CAD.
Summary
In this research study, the efficacy and safety of P2Y12 inhibitor monotherapy versus aspirin monotherapy were compared in patients with established coronary artery disease (CAD). The researchers conducted a patient-level meta-analysis, pooling data from seven randomized trials involving 24,325 participants, with 12,178 assigned to P2Y12 inhibitor monotherapy (62.0% on clopidogrel and 38.0% on ticagrelor) and 12,147 assigned to aspirin monotherapy.
The study found that over two years, P2Y12 inhibitor monotherapy demonstrated a lower risk of the primary composite outcome, which included cardiovascular death, myocardial infarction, and stroke, compared to aspirin monotherapy (HR: 0.88; 95% CI: 0.79-0.97; P = 0.012). This risk reduction was mainly attributed to a decrease in myocardial infarction (HR: 0.77; 95% CI: 0.66-0.90; P < 0.001). Moreover, significant bleeding risks were similar between the two treatment groups (HR: 0.87; 95% CI: 0.70-1.09; P = 0.23), but net adverse clinical events were lower with P2Y12 inhibitors (HR: 0.89; 95% CI: 0.81-0.98; P = 0.020). The study found that the treatment effect was consistent across different subgroups and types of P2Y12 inhibitors.
In conclusion, based on the evidence from this meta-analysis, the authors suggest that P2Y12 inhibitor monotherapy might be a preferred long-term secondary prevention strategy over aspirin monotherapy for patients with established CAD, as it demonstrated superior efficacy and similar overall safety. However, it is essential to note that several authors disclosed ties to the pharmaceutical industry, which may warrant further investigation and consideration in interpreting the results.
Link to the article: https://www.jacc.org/doi/10.1016/j.jacc.2023.04.051
References Gragnano, F., Cao, D., Pirondini, L., Franzone, A., Kim, H.-S., Von Scheidt, M., Pettersen, A.-Å. R., Zhao, Q., Woodward, M., Chiarito, M., McFadden, E. P., Park, K. W., Kastrati, A., Seljeflot, I., Zhu, Y., Windecker, S., Kang, J., Schunkert, H., Arnesen, H., … Valgimigli, M. (2023). P2y12 inhibitor or aspirin monotherapy for secondary prevention of coronary events. Journal of the American College of Cardiology, 82(2), 89–105. https://doi.org/10.1016/j.jacc.2023.04.051
