, and CADET. The study population consisted of 24,325 patients from these seven trials, of which 12,178 were assigned to P2Y12 inhibitor monotherapy and 12,147 were assigned to aspirin monotherapy. The median treatment duration was 557 days.
The benefit of the P2Y12 inhibitor monotherapy over aspirin was driven by a reduction in MI . The number needed to treat to prevent one MI with a P2Y12 inhibitor was 136 patients. The risk for definite or probable stent thrombosis in patients undergoing PCI was also significantly reduced, by more than 50%.
"This may be overinterpretation of the data, but this observation fits quite well with the finding of a remarkably large reduction in stent thrombosis with P2Y12 inhibitors versus aspirin," he commented.Discussant of the study at the ESC Hotline session, Steffen Massberg, MD, University Hospital Munich, called this"a very important, well-performed, contemporary analysis," and said that"the findings have important clinical implications.
In the past few years, several other studies have looked at this question — including the larger GLASSY, TICAB, and HOST-EXAM trials — and when the data from all these trials were combined in the PANTHER meta-analysis, a"moderate" benefit was seen on the composite ischemic endpoint with a P2Y12 inhibitor, he said. Results also suggest a particular benefit of P2Y12 inhibitors in patients who have undergone PCI.
"My personal take is that these results are very important and will affect clinical practice, but I believe aspirin is still a valid standard, as it is associated with better compliance and fewer off-target side effects , less variation in treatment response , and most likely is more cost-effective," he commented.