Ticagrelor Monotherapy Versus Ticagrelor With Aspirin in Patients With ST-Segment Elevation Myocardial Infarction
Seung-Jun Lee, Jae Young Cho, Byeong-Keuk Kim, Kyeong Ho Yun, Yongsung Suh, Yun-Hyeong Cho, Yong Hoon Kim, Ae-Young Her, Sungsoo Cho, Dong Woon Jeon, Sang-Yong Yoo, Deok-Kyu Cho, Bum-Kee Hong, Hyuck Moon Kwon, Sung-Jin Hong, Chul-Min Ahn, Dong-Ho Shin, Chung-Mo Nam, Jung-Sun Kim, Young-Guk Ko, Donghoon Choi, Myeong-Ki Hong, Yangsoo Jang, TICO Investigators, Seung-Jun Lee, Jae Young Cho, Byeong-Keuk Kim, Kyeong Ho Yun, Yongsung Suh, Yun-Hyeong Cho, Yong Hoon Kim, Ae-Young Her, Sungsoo Cho, Dong Woon Jeon, Sang-Yong Yoo, Deok-Kyu Cho, Bum-Kee Hong, Hyuck Moon Kwon, Sung-Jin Hong, Chul-Min Ahn, Dong-Ho Shin, Chung-Mo Nam, Jung-Sun Kim, Young-Guk Ko, Donghoon Choi, Myeong-Ki Hong, Yangsoo Jang, TICO Investigators
Abstract
Objectives: The aim of this study was to assess whether the effects of ticagrelor monotherapy after 3-month dual-antiplatelet therapy (DAPT) are consistent among patients presenting with ST-segment elevation myocardial infarction (STEMI), non-ST-segment elevation myocardial infarction, and unstable angina treated with drug-eluting stents.
Background: Ticagrelor monotherapy after short-term DAPT has not been investigated in patients with STEMI.
Methods: This was a pre-specified, stratified, subgroup analysis of the STEMI cohort from the TICO (Ticagrelor Monotherapy After 3 Months in the Patients Treated With New Generation Sirolimus Stent for Acute Coronary Syndrome) trial, which constituted 36% of the total population. The primary outcome was a composite of major bleeding and major adverse cardiac and cerebrovascular events (MACCE; death, myocardial infarction, stent thrombosis, stroke, or target vessel revascularization). The secondary outcomes were major bleeding and MACCE.
Results: The incidence of the primary outcome was 4.4% in patients with STEMI (n = 1,103), 6.0% in those with non-ST-segment elevation myocardial infarction (n = 1,027), and 4.1% in those with unstable angina (n = 926), without statistical significance (p = 0.09). Compared with ticagrelor-based 12-month DAPT, ticagrelor monotherapy after 3-month DAPT showed consistent effects on the primary outcome across clinical presentations (p for interaction [pint] = 0.64). Furthermore, the effect of ticagrelor monotherapy on the reduction of major bleeding was consistent across clinical presentations (pint = 0.36). The effect of ticagrelor monotherapy on MACCE was also consistent in patients with STEMI, without evidence of a higher risk for MACCE (pint = 0.14).
Conclusions: This pre-specified subgroup analysis revealed no heterogeneity in the effects of ticagrelor monotherapy after 3-month DAPT, compared with 12-month DAPT, for the primary outcome, major bleeding, and MACCE across clinical presentations including STEMI, though larger studies are needed to demonstrate these findings with adequate power. (Ticagrelor Monotherapy After 3 Months in the Patients Treated With New Generation Sirolimus Stent for Acute Coronary Syndrome [TICO Study]; NCT02494895).
Keywords: ST-segment elevation myocardial infarction; drug-eluting stent(s); dual-antiplatelet therapy.
Conflict of interest statement
Funding Support and Author Disclosures This study was funded by Biotronik (Bülach, Switzerland) and supported by the Cardiovascular Research Center (Seoul, South Korea). The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Copyright © 2021 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
Source: PubMed