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KMID : 0368120220520040324
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Korean Circulation Journal
2022 Volume.52 No. 4 p.324 ~ p.337
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Ticagrelor Monotherapy After 3-Month Dual Antiplatelet Therapy in Acute Coronary Syndrome by High Bleeding Risk: The Subanalysis From the TICO Trial
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Lee Yong-Joon
Suh Yong-Sung
Kim Jung-Sun
Cho Yun-Hyeong
Yun Kyeong-Ho
Kim Yong-Hoon
Cho Jae-Young
Her Ae-Young
Cho Sung-Soo
Jeon Dong-Woon
Yoo Sang-Yong
Cho Deok-Kyu
Hong Bum-Kee
Kwon Hyuck-Moon
Hong Sung-Jin
Ahn Chul-Min
Shin Dong-Ho
Nam Chung-Mo
Kim Byeong-Keuk
Ko Young-Guk
Choi Dong-Hoon
Hong Myeong-Ki
Jang Yang-Soo
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Abstract
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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.
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KEYWORD
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Acute coronary syndrome, Ticagrelor, Hemorrhage
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