{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T02:39:53Z","timestamp":1793759993932,"version":"4.6.1"},"reference-count":36,"publisher":"American Medical Association (AMA)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Cardiol"],"published-print":{"date-parts":[[2024,5,1]]},"abstract":"\n Importance<\/jats:title>\n \n Among patients undergoing percutaneous coronary intervention (PCI), it remains unclear whether the treatment efficacy of P2Y\n 12<\/jats:sub>\n inhibitor monotherapy after a short course of dual antiplatelet therapy (DAPT) depends on the type of P2Y\n 12<\/jats:sub>\n inhibitor.\n <\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To assess the risks and benefits of ticagrelor monotherapy or clopidogrel monotherapy compared with standard DAPT after PCI.<\/jats:p>\n <\/jats:sec>\n \n Data Sources<\/jats:title>\n MEDLINE, Embase, TCTMD, and the European Society of Cardiology website were searched from inception to September 10, 2023, without language restriction.<\/jats:p>\n <\/jats:sec>\n \n Study Selection<\/jats:title>\n \n Included studies were randomized clinical trials comparing P2Y\n 12<\/jats:sub>\n inhibitor monotherapy with DAPT on adjudicated end points in patients without indication to oral anticoagulation undergoing PCI.\n <\/jats:p>\n <\/jats:sec>\n \n Data Extraction and Synthesis<\/jats:title>\n Patient-level data provided by each trial were synthesized into a pooled dataset and analyzed using a 1-step mixed-effects model. The study is reported following the Preferred Reporting Items for Systematic Review and Meta-Analyses of Individual Participant Data.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n The primary objective was to determine noninferiority of ticagrelor or clopidogrel monotherapy vs DAPT on the composite of death, myocardial infarction (MI), or stroke in the per-protocol analysis with a 1.15 margin for the hazard ratio (HR). Key secondary end points were major bleeding and net adverse clinical events (NACE), including the primary end point and major bleeding.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Analyses included 6 randomized trials including 25\u202f960 patients undergoing PCI, of whom 24\u202f394 patients (12\u202f403 patients receiving DAPT; 8292 patients receiving ticagrelor monotherapy; 3654 patients receiving clopidogrel monotherapy; 45 patients receiving prasugrel monotherapy) were retained in the per-protocol analysis. Trials of ticagrelor monotherapy were conducted in Asia, Europe, and North America; trials of clopidogrel monotherapy were all conducted in Asia. Ticagrelor was noninferior to DAPT for the primary end point (HR, 0.89; 95% CI, 0.74-1.06;\n P<\/jats:italic>\n for noninferiority\u2009=\u2009.004), but clopidogrel was not noninferior (HR, 1.37; 95% CI, 1.01-1.87;\n P<\/jats:italic>\n for noninferiority\u2009&amp;gt;\u2009.99), with this finding driven by noncardiovascular death. The risk of major bleeding was lower with both ticagrelor (HR, 0.47; 95% CI, 0.36-0.62;\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001) and clopidogrel monotherapy (HR, 0.49; 95% CI, 0.30-0.81;\n P<\/jats:italic>\n \u2009=\u2009.006;\n P<\/jats:italic>\n for interaction\u2009=\u20090.88). NACE were lower with ticagrelor (HR, 0.74; 95% CI, 0.64-0.86,\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001) but not with clopidogrel monotherapy (HR, 1.00; 95% CI, 0.78-1.28;\n P<\/jats:italic>\n \u2009=\u2009.99;\n P<\/jats:italic>\n for interaction\u2009=\u2009.04).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n This systematic review and meta-analysis found that ticagrelor monotherapy was noninferior to DAPT for all-cause death, MI, or stroke and superior for major bleeding and NACE. Clopidogrel monotherapy was similarly associated with reduced bleeding but was not noninferior to DAPT for all-cause death, MI, or stroke, largely because of risk observed in 1 trial that exclusively included East Asian patients and a hazard that was driven by an excess of noncardiovascular death.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamacardio.2024.0133","type":"journal-article","created":{"date-parts":[[2024,3,20]],"date-time":"2024-03-20T11:00:58Z","timestamp":1710932458000},"page":"437","source":"Crossref","is-referenced-by-count":98,"title":["Ticagrelor or Clopidogrel Monotherapy vs Dual Antiplatelet Therapy After Percutaneous Coronary Intervention"],"prefix":"10.1001","volume":"9","author":[{"given":"Marco","family":"Valgimigli","sequence":"first","affiliation":[{"name":"Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland"},{"name":"Department of Cardiology, Bern University Hospital, University of Bern, Bern, 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