Background: With the publication of a large number of clinical studies
on antiplatelet therapy in recent years, it is still controversial which
antiplatelet monotherapy should be continued after a period of dual antiplatelet
therapy (DAPT) in the post percutaneous coronary intervention (post-PCI)
population. We conducted a meta-analysis to investigate the efficacy and safety
of P2Y inhibitors versus aspirin in the post-PCI population after
completing DAPT. Methods: We searched studies in electronic databases
from January 1, 2015 to November 20, 2022. We conducted a meta-analysis to
estimate the effect of P2Y inhibitor monotherapy on clinical end-points in
post-PCI patients after a period of DAPT, using trial-level data with consistent
end-point definitions. The primary outcome was major adverse cardiovascular events
(MACE). Odd ratio (OR) was pooled with 95% confidence interval (CI) for
dichotomous data. This study is registered with INPLASY 2022120011.
Results: We included five studies that included 24,460 patients. The
patients who received a P2Y inhibitor showed a lower risk of MACE than
patients who received aspirin (OR 0.70 [95% CI 0.60–0.80], I = 0%,
p 0.00001) monotherapy. Subgroup analysis of MACE based on patient
characteristics showed consistent results with the main analysis. The risk of
major bleeding was similar in patients who received a P2Y inhibitor and
those who received aspirin (OR 0.86 [95% CI 0.53–1.39], I = 57%,
p = 0.54). The risk of major bleeding was borderline increased in
patients who received ticagrelor versus aspirin (OR 1.81 [95% CI 0.99–3.31],
p = 0.05). Conclusions: In the post-PCI population, P2Y
inhibitor monotherapy may be superior to aspirin for MACE, repeat
revascularization, and stroke without increasing the risk of major bleeding.