Efficacy and safety of ticagrelor monotherapy in patients undergoing percutaneous coronary intervention: a meta-analysis.

Dual antiplatelet therapy (DAPT) and subsequent P2Y12 inhibitor monotherapy, particularly ticagrelor, is an emerging treatment strategy in patients undergoing percutaneous coronary intervention (PCI). This meta-analysis was designed to investigate whether short-term DAPT followed by ticagrelor monotherapy is associated with a favorable outcome as compared to standard DAPT. 1-3 months of DAPT was termed "short-term" DAPT, 6-12 months DAPT was termed "standard" DAPT. The primary outcome was the composite of major adverse cardiovascular events (MACE) comprising myocardial infarction, stroke and cardiovascular death. Secondary outcomes included all-cause mortality and net adverse clinical events (NACE: myocardial infarction, stroke, all-cause death, stent thrombosis, major bleeding). The primary safety outcome was major bleeding. Three studies comprising 26.143 patients were included. The risk of MACE was similar between the two treatment groups (RR 0.86, 95% CI, 0.76-1.24, p=0.08, I2 =22%). Short-term DAPT followed by ticagrelor monotherapy resulted in a 20% relative risk reduction of all-cause mortality (RR 0.80, 95% CI, 0.65-0.98, p=0.03, I2 =0%) and an 18% relative risk reduction of NACE (RR 0.82, 95% CI, 0.71-0.94, p=0.005, I2 =33%) as compared with standard DAPT. Short-term DAPT followed by ticagrelor monotherapy significantly decreased the risk of major bleeding (RR 0.67, 95% CI, 0.49-0.92, p=0.01, I2 =65%). In ACS patients, short-term DAPT followed by ticagrelor monotherapy resulted in an unchanged ischemic risk but a significantly lower bleeding risk compared with standard DAPT. Short-term DAPT followed by ticagrelor monotherapy compared with standard DAPT resulted in a favorable safety and efficacy profile. Direct comparisons of aspirin versus ticagrelor monotherapy following PCI are needed.