The use of aspirin as chronic antiplatelet therapy after percutaneous coronary intervention (PCI) has historically been the standard recommended by international guidelines. However, recent studies have suggested that P2Y12 receptor inhibitors may represent a more effective alternative for maintenance therapy.
The study evaluated the efficacy and safety of clopidogrel monotherapy compared with aspirin beyond 12 months after PCI in high-risk patients.
This was an analysis of the PCI registry from Fuwai Hospital in Beijing, China. Among 13,090 patients who underwent PCI with second-generation drug-eluting stents, 5,664 high ischemic risk patients who remained event-free at one year were included (65% presented with ACS).
The primary endpoint was NACE (net adverse clinical events) between 12 and 36 months, defined as a composite of death, myocardial infarction, stroke, or BARC ≥2 bleeding.
During the 36-month follow-up, clopidogrel monotherapy was associated with a significant reduction in events:
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NACE: 2.5% vs 4.7% with aspirin (HR 0.52; p<0.001)
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MACCE: 57% reduction (HR 0.43; p<0.001)
Rates of clinically relevant bleeding were similar between both groups.
These results reinforce the hypothesis that a strategy based on P2Y12 inhibitors may represent a valid alternative to aspirin for long-term antiplatelet therapy after PCI.
Presented by Hao-Yu Wang at the Late Breaking Clinical Trials, CRT 2026, Washington, USA.
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