Ticagrelor Monotherapy After 3-Month Dual Antiplatelet Therapy in Acute Coronary Syndrome by High Bleeding Risk: The Subanalysis From the TICO Trial
- Author:
Yong-Joon LEE
1
;
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
Author Information
- Publication Type:Original Research
- From:Korean Circulation Journal 2022;52(4):324-337
- CountryRepublic of Korea
- Language:English
-
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 (PRECISEDAPT) 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
