Effect of P2Y12 Inhibitor Monotherapy vs Dual Antiplatelet Therapy on Cardiovascular Events in Patients Undergoing Percutaneous Coronary Intervention The SMART-CHOICE Randomized Clinical Trial -

Effect of P2Y12 Inhibitor Monotherapy vs Dual Antiplatelet Therapy on Cardiovascular Events in Patients Undergoing Percutaneous Coronary Intervention The SMART-CHOICE Randomized Clinical Trial
Information type: Randomised controlled trials
Source: Journal of the American Medical Association
Specialities: Cardiovascular system disorders | Haematological disorders | Surgery
Summary
In this RCT (n=2912) P2Y12 inhibitor monotherapy after 3-month duration of DAPT resulted in a noninferior rate of major cardiovascular events (all-cause death, MI, and stroke) vs prolonged DAPT at 12 months (2.9% vs 2.5%; difference 0.4%; P=0.007 for non-inferiority).
UKMi comment

A separate study (STOPDAPT-2) also published in this issue of the Journal of American Medical Association evaluated 12 months of DAPT vs 1 month of DAPT followed by clopidogrel monotherapy and reported 1-month DAPT was both noninferior and superior to 12-month DAPT for the primary end point.

A related editorial notes although the studies used somewhat different 1-year efficacy and safety end points, both reached the same conclusions. The shorter DAPT regimens were noninferior to the more traditional 12-month regimens regarding major ischaemic events. Both studies report rate of bleeding was significantly lower in the P2Y12 inhibitor monotherapy group compared to the DAPT group.
Related links: Editorial STOPDAPT-2 study