Impact of preprocedural coronary flow grade on duration of dual antiplatelet therapy in acute myocardial infarction

Yong Hoon Kim, Ae-Young Her, Byeong-Keuk Kim, Sung-Jin Hong, Chul-Min Ahn, Jung-Sun Kim, Young-Guk Ko, Donghoon Choi, Myeong-Ki Hong, Yangsoo Jang, Yong Hoon Kim, Ae-Young Her, Byeong-Keuk Kim, Sung-Jin Hong, Chul-Min Ahn, Jung-Sun Kim, Young-Guk Ko, Donghoon Choi, Myeong-Ki Hong, Yangsoo Jang

Abstract

We investigated the impact of pre-percutaneous coronary intervention (pre-PCI) thrombolysis in myocardial infarction (TIMI) flow grade (pre-TIMI) on 3-month (3-mo) and 12-mo of dual antiplatelet therapy (DAPT) in patients with acute myocardial infarction (AMI). This was a post hoc analysis of the TICO trial. A total of 2083 patients with AMI (pre-TIMI 0/1: n = 1143; pre-TIMI 2/3: n = 940) were evaluated. The primary outcome was the occurrence of net adverse clinical events (NACE), defined as a composite of TIMI major bleeding and major adverse cardiac and cerebrovascular events (MACCE) within 12-mo following PCI. The secondary outcomes were the occurrence of the individual components of TIMI bleedings and MACCE. In the pre-TIMI 0/1 group, the primary and second outcomes were not significantly different between the 3-mo and 12-mo DAPT groups. However, in the pre-TIMI 2/3 group, the occurrences of TIMI minor (adjusted hazard ratio [aHR]: 0.294; p = 0.016) and major or minor bleeding (aHR: 0.483; p = 0.014) on intention-to-treat analysis were significantly higher in the 12-mo than in the 3-mo DAPT group. The occurrence of MACCE was similar between the two groups. A higher bleeding tendency in 12-mo DAPT compared with 3-mo DAPT was more obvious in the pre-TIMI 2/3 group than in the pre-TIMI 0/1 group.Clinical Trial Registration: URL: http://www.clinicaltrials.gov . Unique identifier: NCT02494895.

Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
Time-to-event curves for NACE (a and b), TIMI major bleeding (c and d), TIMI minor bleeding (e and f), TIMI major or minor bleeding (g and h), and MACCE (i and j) in pre-PCI TIMI flow grade 0/1 (a, c, e, g, and i) and 2/3 groups (b, d, f, h, and j).
Figure 1
Figure 1
Time-to-event curves for NACE (a and b), TIMI major bleeding (c and d), TIMI minor bleeding (e and f), TIMI major or minor bleeding (g and h), and MACCE (i and j) in pre-PCI TIMI flow grade 0/1 (a, c, e, g, and i) and 2/3 groups (b, d, f, h, and j).
Figure 2
Figure 2
Subgroup analysis for NACE in pre-TIMI flow grade 0/1 group. NACE net adverse clinical event, Pre-PCI pre-percutaneous coronary intervention, TIMI Thrombolysis In Myocardial Infarction, 3-mo DAPT, ticagrelor monotherapy after 3-month dual antiplatelet therapy, 12-mo DAPT ticagrelor-based 12-month dual antiplatelet therapy, HR hazard ratio, CI confidence interval, BMI body mass index, eGFR estimated glomerular filtration rate, NSTEMI non-ST segment elevation myocardial infarction, STEMI ST segment elevation myocardial infarction.
Figure 3
Figure 3
Subgroup analysis for NACE in pre-TIMI flow grade 2/3 group. NACE net adverse clinical event, Pre-PCI pre-percutaneous coronary intervention, TIMI Thrombolysis In Myocardial Infarction, 3-mo DAPT, ticagrelor monotherapy after 3-month dual antiplatelet therapy, 12-mo DAPT ticagrelor-based 12-month dual antiplatelet therapy, HR hazard ratio, CI confidence interval, BMI body mass index, eGFR estimated glomerular filtration rate, NSTEMI non-ST segment elevation myocardial infarction, STEMI ST segment elevation myocardial infarction.
Figure 4
Figure 4
Flowchart. TICO Ticagrelor Monotherapy After 3 Months in the Patients Treated With New Generation Sirolimus-eluting Stent for Acute Coronary Syndrome, Pre-PCI pre-percutaneous coronary intervention, TIMI Thrombolysis In Myocardial Infarction, DAPT dual antiplatelet therapy.

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