Ticagrelor Monotherapy After 3-Month Dual Antiplatelet Therapy in Acute Coronary Syndrome by High Bleeding Risk: The Subanalysis From the TICO Trial
Year: 2022
Type: article
Abstract: BACKGROUND AND OBJECTIVES: 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). METHODS: 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). RESULTS: 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; p<0.001; by PRECISE-DAPT score: HR, 3.09; 95% CI, 1.92-4.98; p<0.001). 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). CONCLUSIONS: 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. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02494895.
Source: Korean Circulation Journal
Authors: 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, for the TICO investigators
Institutions: Yonsei University, Severance Hospital, Myongji Hospital, Hanyang University, Wonkwang University Hospital, Kangwon National University, Dankook University Hospital, National Health Insurance Service Ilsan Hospital, University of Ulsan, Gangneung Asan Hospital, Yongin Severance Hospital, Gangnam Severance Hospital, Yonsei University Health System, CHA University Bundang Medical Center, CHA University
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Funder: Biotronik
OpenAlex ID: W4206239012