P2Y12 Inhibitor Monotherapy Versus Dual Antiplatelet Therapy in Acute Coronary Syndrome Post Percutaneous Coronary Intervention: A Meta-Analysis of Randomized Controlled Trials

Introduction: Dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 inhibitor is the standard post-percutaneous coronary intervention (PCI) therapy but is associated with increased risk of bleeding. This meta-analysis compares clinical outcomes with P2Y12 inhibitor monotherapy and DAPT in patients with acute coronary syndromes (ACS) post-PCI. Methods: Databases such as PubMed, EMBASE, Scopus, Cochrane, CENTRAL, Google Scholar and Web of Science were queried until June 2024 for relevant randomized controlled trials (RCT). Outcomes included the incidence of TIMI (Thrombolysis in Myocardial Infarction) major and minor bleeding, and major adverse cardiovascular events (MACE). RevMan (version 5.3) was used to calculate hazard ratio (HR) with 95% confidence intervals (CI); a p-value of less than 0.05 was considered significant. Results: Seven RCTs with 36,015 participants (mean follow-up = 12 months) were included. P2Y12 inhibitor monotherapy led to a statistically significant reduction in TIMI major and minor bleeding incidence (HR = 0.53, 95% CI: 0.41, 0.68; p < 0.0001) compared to DAPT. Both treatments, however, displayed a similar protection against MACEs (HR = 0.95; 95% CI: 0.83,1.10; p = 0.5). There was a significant reduction in net adverse clinical events with P2Y12 inhibitor monotherapy, compared to DAPT (HR = 0.77, 95%CI: 0.64, 0.93; p = 0.006) Conclusion: This meta-analysis concludes a lower incidence of bleeding and a reduction in net adverse clinical events with P2Y12 inhibitor monotherapy compared to DAPT. Larger multicentric randomized evidence is warranted to validate P2Y12 inhibitor monotherapy compared to DAPT.