P2Y₁₂ inhibitor monotherapy was associated with lower risks of cardiovascular death, myocardial infarction (MI), and stroke compared with aspirin monotherapy in patients with coronary artery disease, based on findings from the PANTHER study presented Aug. 29 during ESC Congress 2022 in Barcelona.

Investigators identified seven trials after full text review – ASCET, CADET, CAPRIE, DACAB, GLASSY, HOST-EXAM and TiCAB – with 35,752 individual participants from 492 sites across Europe, Asia and North America. After accounting for exclusions, the final study population consisted of 24,325 patients, of whom 12,178 were assigned to P2Y₁₂ inhibitor monotherapy (clopidogrel or ticagrelor) and 12,147 were assigned to aspirin monotherapy.

The median treatment duration was 557 days and the pre-specified primary efficacy outcome was the composite of cardiovascular death, myocardial infarction and stroke. The pre-specified key secondary outcomes were major bleeding and net adverse clinical events (NACE). Other secondary outcomes assessed the individual components of the primary outcome, all-cause death, definite and/or probable stent thrombosis, ischemic or haemorrhagic stroke and gastrointestinal bleeding.

Overall, the primary outcome occurred in 5.5% of patients in the P2Y12 inhibitor group compared with 6.3% in the aspirin group. The primary safety outcomes of major bleeding and NACE were 1.2% and 6.4%, respectively, in the P2Y12 inhibitor group vs. 1.4% and 7.2% in the aspirin group.

"Based on available randomized evidence, long-term P2Y12 inhibitor monotherapy may be warranted instead of long-term aspirin monotherapy for secondary prevention in patients with coronary artery disease," said Marco Valgimigli, MD, PhD, who presented the study findings.

Clinical Topics: Invasive Cardiovascular Angiography and Intervention, Vascular Medicine, Atherosclerotic Disease (CAD/PAD), Interventions and Coronary Artery Disease, Interventions and Vascular Medicine

Keywords: ESC Congress, ESC22, ACC International, Coronary Artery Disease, Aspirin, Ticagrelor, Clopidogrel, Hemorrhagic Stroke, Myocardial Infarction, Stents, Gastrointestinal Hemorrhage, Thrombosis

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