Aspirin or P2Y12 inhibitor for coronary artery disease?

By Dr. Jonathan Shurlock, edited by Dr. Ahmed El-Medany

Professor Marco Valgimigli presented the findings of the PANTHER analysis at the 2022 ESC congress. Currently lifelong aspirin is the standard of care following a course of dual antiplatelet therapy for a defined period of time, in the context of acute coronary syndrome or percutaneous coronary intervention.

The PANTHER meyta-analysis aimed to address uncertainty around the effectiveness of antiplatelet monotherapy using the currently utilised agents (clopidogrel, prasugrel, ticagrelor) and compare this effect with aspirin monotherapy.

Seven eligible trials were identified (ASCET, CADET, CAPRIE, DACAB, GLASSY, HOST-EXAM, and TiCAB) resulting in a total 35,752 participants from 492 sites. After further assessment criteria 24,325 participants were assigned to P2Y12 inhibitor monotherapy (ticagrelor or clopidogrel) and 12,147 to aspirin monotherapy. Median treatment length was 557 days and the average age of participants was 64.3 years.

The primary composite outcome of CV death, MI, and stroke was lower in those receiving P2Y12 inhibitor monotherapy compared with aspirin (5.5% vs. 6.3%; hazard ratio [HR] 0.88; 95% confidence interval [CI] 0.79–0.97; p=0.014). The risk of major bleeding was similar between groups (1.2% vs. 1.4%; HR 0.87; 95% CI 0.70–1.09; p=0.23).

Professor Marco Valgimigli reported that: “the findings from our analysis, […] support a paradigm shift toward single P2Y12 inhibition for secondary prevention in the long-term antithrombotic management of patients with coronary artery disease.”

This extensive work adds evidence to the discussion regarding appropriate antiplatelet therapy for this patient group, and warrants further consideration and decision making.

See the ESC press release here: