After cardiac catheterization: Clopidogrel & Co. more effective in the long term than ASA

After percutaneous transluminal coronary angioplasty (PCI), patients typically initially receive dual antiplatelet therapy with acetylsalicylic acid (ASA) and a _P2Y12 inhibitor such as clopidogrel or ticagrelor for several months. Long-term secondary prevention is traditionally performed with ASA alone—a concept based on studies from the 1970s. Current data favor monotherapy with a P2Y12 inhibitor.

In a meta-analysis , the data of which have now been published in the scientific journal »British Medical Journal (BMJ)« , researchers led by Professor Dr. Daniele Giacoppo from the Department of General Surgery and Medical-Surgical Specialties at the University of Catania , Italy , investigated whether long-term prevention after percutaneous coronary intervention (PCI) with a P2Y12 inhibitor is more effective in protecting against serious cardiovascular events.

To this end, the researchers analyzed data from five controlled clinical trials with a total of 16,117 patients who were treated with either a P2Y12 inhibitor or aspirin after elective or acute PCI and completion of dual antiplatelet therapy (DAPT). The median follow-up time for the study population was approximately 3.7 years, and in sub-analyses even approximately 5.5 years.

The researchers chose major adverse cardiac and cerebrovascular events (MACCE) as primary endpoints, including cardiovascular death, myocardial infarction and stroke , as well as major bleeding as a potential adverse effect of platelet inhibition.

The secondary endpoints included a net composite endpoint for cardiac and cerebrovascular events (NACCE), resulting from the combination of the primary and co-primary endpoints, as well as individual ischemic events and bleeding .