Abstract 4358860: Comparative Efficacy and Safety of P2Y12 Inhibitors versus Aspirin Monotherapy Following Dual Antiplatelet Therapy in Patients undergoing Percutaneous Coronary Intervention: A Systematic Review and Meta-Analysis

Background: After percutaneous coronary intervention (PCI), dual antiplatelet therapy (DAPT) is typically followed by long-term aspirin monotherapy, but emerging evidence suggests P2Y12 inhibitors may offer improved outcomes. The optimal choice of single antiplatelet therapy after DAPT remains uncertain. This study aims to compare the efficacy and safety of P2Y12 inhibitors versus aspirin monotherapy in post-PCI patients. Methods: A systematic review and meta-analysis was conducted in accordance with PRISMA guidelines. PubMed, Cochrane Library, and Google Scholar were searched from inception till April 2025. We conducted the statistical analysis using RevMan, version 5.4, using a random-effects model to pool odds ratios (ORs) along with 95% confidence intervals (CIs) for all outcomes. A p-value of less than 0.05 was considered statistically significant. Results: We pooled 7 studies (3 RCTs, 4 observational) including a total of 29,756 patients (P2Y12: 13,523; aspirin: 16,233). P2Y12 inhibitor monotherapy was associated with a significant reduction in major adverse cardiovascular events (MACE) compared to aspirin [OR: 0.73; 95% CI: 0.64–0.84; p < 0.0001]. It also significantly reduced the risk of repeat revascularization [OR: 0.83; 95% CI: 0.73–0.94; p = 0.004] and stroke [OR: 0.63; 95% CI: 0.48–0.81; p = 0.0004]. No significant difference was observed in all-cause mortality [OR: 0.90; 95% CI: 0.77–1.05; p = 0.19], cardiac death [OR: 0.86; 95% CI: 0.68–1.09; p = 0.22], major bleeding [OR: 1.06; 95% CI: 0.67–1.68; p = 0.81], myocardial infarction [OR: 0.78; 95% CI: 0.56–1.08; p = 0.14], or stent thrombosis [OR: 0.71; 95% CI: 0.41–1.22; p = 0.21]. Conclusion: P2Y12 inhibitor monotherapy is associated with a significantly lower risk of MACE, repeat revascularization, and stroke compared to aspirin monotherapy, without increasing the risk of major bleeding or mortality. These findings support the potential role of P2Y12 inhibitors as a safer and more effective long-term antiplatelet therapy post-PCI. Further large-scale randomized trials are warranted to confirm these results and guide future clinical practice.