Ticagrelor or Clopidogrel Monotherapy vs Dual Antiplatelet Therapy After Percutaneous Coronary Intervention

作者：Marco Valgimigli, Felice Gragnano, Mattia Branca, Anna Franzone, Bruno R. da Costa, Usman Baber, Takeshi Kimura, Yangsoo Jang, Joo‐Yong Hahn, Qiang Zhao, Stephan Windecker, C. Michael Gibson, Hirotoshi Watanabe, Byeong‐Keuk Kim, Young Bin Song, Yunpeng Zhu, Pascal Vranckx, Shamir R. Mehta, Kenji Ando, Sung‐Jin Hong, Hyeon‐Cheol Gwon, Patrick W. Serruys, George Dangas, Eugène McFadden, Dominick J. Angiolillo, Dik Heg, Paolo Calabrò, Peter Jüni, Roxana Mehran · 发表于：JAMA Cardiology · 年份：2024 · DOI：10.1001/jamacardio.2024.0133 · 被引用次数：89 · 研究领域：Antiplatelet Therapy and Cardiovascular Diseases、Atrial Fibrillation Management and Outcomes、Acute Myocardial Infarction Research

Importance: Among patients undergoing percutaneous coronary intervention (PCI), it remains unclear whether the treatment efficacy of P2Y12 inhibitor monotherapy after a short course of dual antiplatelet therapy (DAPT) depends on the type of P2Y12 inhibitor. Objective: To assess the risks and benefits of ticagrelor monotherapy or clopidogrel monotherapy compared with standard DAPT after PCI. Data Sources: MEDLINE, Embase, TCTMD, and the European Society of Cardiology website were searched from inception to September 10, 2023, without language restriction. Study Selection: Included studies were randomized clinical trials comparing P2Y12 inhibitor monotherapy with DAPT on adjudicated end points in patients without indication to oral anticoagulation undergoing PCI. Data Extraction and Synthesis: Patient-level data provided by each trial were synthesized into a pooled dataset and analyzed using a 1-step mixed-effects model. The study is reported following the Preferred Reporting Items for Systematic Review and Meta-Analyses of Individual Participant Data. Main Outcomes and Measures: The primary objective was to determine noninferiority of ticagrelor or clopidogrel monotherapy vs DAPT on the composite of death, myocardial infarction (MI), or stroke in the per-protocol analysis with a 1.15 margin for the hazard ratio (HR). Key secondary end points were major bleeding and net adverse clinical events (NACE), including the primary end point and major bleeding. Results: Analyses include...