P2y12 inhibitor monotherapy after 1-3 months dual antiplatelet therapy in patients with coronary artery disease and chronic kidney disease undergoing percutaneous coronary intervention: a meta-analysis of randomized controlled trials

Yanqiao Yu; Deng Pan; Ruina Bai; Jinwen Luo; Yu Tan; Wenhui Duan; Dazhuo Shi

doi:10.3389/fcvm.2023.1197161

P2y₁₂ inhibitor monotherapy after 1-3 months dual antiplatelet therapy in patients with coronary artery disease and chronic kidney disease undergoing percutaneous coronary intervention: a meta-analysis of randomized controlled trials

Front Cardiovasc Med. 2023 Jul 6:10:1197161. doi: 10.3389/fcvm.2023.1197161. eCollection 2023.

Authors

Yanqiao Yu^{1

2}, Deng Pan^{1

2}, Ruina Bai³, Jinwen Luo², Yu Tan², Wenhui Duan³, Dazhuo Shi³

Affiliations

¹ Department of Graduate School, Beijing University of Chinese Medicine, Beijing, China.
² Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China.
³ National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China.

Abstract

Introduction: In patients with coronary artery disease (CAD) and chronic kidney disease (CKD) undergoing percutaneous coronary intervention (PCI), whether short-term dual antiplatelet therapy (DAPT) followed by P2Y₁₂ inhibitors confers benefits compared with standard DAPT remains unclear. This study aimed to assess the efficacy and safety of 1-3 months of DAPT followed by P2Y₁₂ monotherapy in patients with CAD and CKD undergoing PCI.

Methods: PubMed, Embase, and the Cochrane Library were searched to identify randomized controlled trials (RCTs) comparing the P2Y₁₂ inhibitor monotherapy after a 1-3 months DAPT vs. DAPT in patients with CAD and CKD after PCI. The primary outcome was the incidence of major adverse cardiovascular events (MACEs), defined as a composite of all-cause mortality, myocardial infarction, stent thrombosis, target-vessel revascularization, and stroke. The safety outcome was the major bleeding events, defined as a composite of TIMI major bleeding or Bleeding Academic Research and Consortium (BARC) type 2, 3, or 5 bleeding. The pooled risk ratios (RRs) with 95% confidence intervals (CIs) were calculated with a fixed- or random-effects model depending on the heterogeneity among studies.

Results: Four RCTs including 20,468 patients (2,833 patients with CKD and 17,635 without CKD) comparing P2Y₁₂ inhibitor monotherapy with DAPT were included in our meta-analysis. Patients with CAD and CKD had higher risk of ischemic and bleeding events. P2Y₁₂ inhibitor monotherapy after 1-3 months of DAPT significantly reduced the risk of major bleeding compared to DAPT in CKD patients (RR: 0.69, 95% CI: 0.51-0.95, P = 0.02) and non-CKD patients (RR: 0.66, 95% CI: 0.49-0.89, P = 0.01). No significant difference regarding MACEs between P2Y₁₂ inhibitor monotherapy and DAPT was found in CKD patients (RR: 0.88, 95% CI: 0.59-1.31, P = 0.53) and non-CKD (RR: 0.91, 95% CI: 0.79-1.04, P = 0.17).

Conclusion: P2Y₁₂ inhibitor monotherapy after 1-3 months of DAPT was an effective strategy for lowering major bleeding complications without increasing the risk of cardiovascular events in patients with CAD and CKD undergoing PCI as compared with DAPT.

Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/, CRD42022355228.

Keywords: P2Y12 inhibitor monotherapy; chronic kidney disease; coronary artery disease; dual antiplatelet therapy; meta-analysis.

Publication types

Review

Grants and funding

This study was supported by the 2019 Clinical collaboration capacity-building project of Chinese and Western medicine for major and complex diseases (Subproject: Residual angina after coronary revascularization).