The following is the summary of “P2Y12 Inhibitors Monotherapy in Patients Undergoing Complex vs Non-Complex Percutaneous Coronary Intervention: A Meta-Analysis of Randomized Trials” published in the January 2023 issue of Heart Journal by Oliva, et al.

After the percutaneous coronary intervention, P2Y12 inhibitor (P2Y12i) monotherapy has emerged as a promising alternative to dual antiplatelet treatment (DAPT) percutaneous coronary intervention (PCI). In high-risk patients, such as those undergoing complex PCI, the early discontinuation of aspirin as part of P2Y12i monotherapy regimens may raise concerns. The purpose of this study was to compare the efficacy and safety of P2Y12i monotherapy following a short course of DAPT (1-3 months) with that following a typical DAPT regimen (12 months) based on PCI complexity. Random effects models were used in their meta-analysis of randomized trials to pool hazard ratios (HRs) and 95% confidence intervals (CIs). The heterogeneity between complex and noncomplex PCI strata was estimated by pooling the within-trial interactions. The research study’s protocol is listed in the Public Register of Systematic Reviews and Open (CRD42021291027).

 There were 31,627 patients in the 5 trials we looked at; of those, 8,328 (or 26.3%) had difficult PCI. There was no evidence of an interaction between complex and noncomplex PCI, with P2Y12i monotherapy being linked with a similar risk of all-cause death, stent thrombosis, and stroke as routine DAPT. The treatment impact of P2Y12i monotherapy versus regular DAPT for myocardial infarction was shown to be heterogeneous (P-interaction =0.027). P2Y12i monotherapy was associated with a lower risk of myocardial infarction in patients who had undergone complicated PCI compared to those who had undergone noncomplex PCI (HR 0.77, 95% CI 0.60-0.99, P=.042) but not in those who had undergone noncomplex PCI (HR 1.09, 95% CI 0.90-1.30, P=.382). 

P2Y12i monotherapy consistently reduced the risk of severe bleeding across both complex and noncomplex PCI subgroups (P-interaction = 0.699). The use of P2Y12i monotherapy following early aspirin withdrawal may be more beneficial and safer for patients having difficult PCI than the use of regular DAPT.