Ticagrelor Monotherapy After 3-Month Dual Antiplatelet Therapy in Acute Coronary Syndrome by High Bleeding Risk: The Subanalysis From the TICO Trial

Autor: Yong-Joon, Lee, Yongsung, Suh, Jung-Sun, Kim, Yun-Hyeong, Cho, Kyeong Ho, Yun, Yong Hoon, Kim, Jae Young, Cho, Ae-Young, Her, Sungsoo, Cho, Dong Woon, Jeon, Sang-Yong, Yoo, Deok-Kyu, Cho, Bum-Kee, Hong, Hyuckmoon, Kwon, Sung-Jin, Hong, Chul-Min, Ahn, Dong-Ho, Shin, Chung-Mo, Nam, Byeong-Keuk, Kim, Young-Guk, Ko, Donghoon, Choi, Myeong-Ki, Hong, Yangsoo, Jang
Rok vydání: 2022
Předmět:
Zdroj: Korean Circulation Journal. 52:324
ISSN: 1738-5555
1738-5520
DOI: 10.4070/kcj.2021.0321
Popis: Identifying patients with high bleeding risk (HBR) is important when making decisions for antiplatelet therapy strategy. This study evaluated the impact of ticagrelor monotherapy after 3-month dual antiplatelet therapy (DAPT) according to HBR in acute coronary syndrome (ACS) patients treated with drug eluting stents (DESs).In this post-hoc analysis of the TICO trial, HBR was defined by 2 approaches: meeting Academic Research Consortium for HBR (ARC-HBR) criteria or Predicting Bleeding Complications in Patients Undergoing Stent Implantation and Subsequent DAPT (PRECISE-DAPT) score ≥25. The primary outcome was a 3-12 months net adverse clinical event (composite of major bleeding and adverse cardiac and cerebrovascular events).Of the 2,980 patients without adverse events during the first 3 months after DES implantation, 453 (15.2%) were HBR by ARC-HBR criteria and 504 (16.9%) were HBR by PRECISE-DAPT score. The primary outcome rate was higher in HBR versus non-HBR patients (by ARC-HBR criteria: hazard ratio [HR], 2.87; 95% confidence interval [CI], 1.76-4.69; p0.001; by PRECISE-DAPT score: HR, 3.09; 95% CI, 1.92-4.98; p0.001). Ticagrelor monotherapy after 3-month DAPT was associated with lower primary outcome rate than ticagrelor-based 12-month DAPT regardless of HBR by ARC-HBR criteria, with similar magnitudes of therapy effect for HBR and non-HBR patients (p-interaction=0.400). Results were consistent by PRECISE-DAPT score (p-interaction=0.178).In ACS patients treated with DESs, ticagrelor monotherapy after 3-month DAPT was associated with lower rate of adverse clinical outcomes regardless of HBR, with similar magnitudes of therapy effect between HBR and non-HBR.ClinicalTrials.gov Identifier: NCT02494895.
Databáze: OpenAIRE
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