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- Title
Ticagrelor monotherapy for acute coronary syndrome: an individual patient data meta-analysis of TICO and T-PASS trials.
- Authors
Lee, Yong-Joon; Shin, Sanghoon; Kwon, Sung Woo; Suh, Yongsung; Yun, Kyeong Ho; Kang, Tae Soo; Lee, Jun-Won; Cho, Deok-Kyu; Park, Jong-Kwan; Bae, Jang-Whan; Kang, Woong Cheol; Kim, Seunghwan; Lee, Seung-Jun; Hong, Sung-Jin; Ahn, Chul-Min; Kim, Jung-Sun; Kim, Byeong-Keuk; Ko, Young-Guk; Choi, Donghoon; Jang, Yangsoo
- Abstract
Background and Aims In patients with acute coronary syndrome (ACS), dual antiplatelet therapy (DAPT) with aspirin and a potent P2Y12 inhibitor is recommended for 12 months after drug-eluting stent (DES) implantation. Monotherapy with a potent P2Y12 inhibitor after short-term DAPT is an attractive option to better balance the risks of ischaemia and bleeding. Therefore, this study evaluated the efficacy and safety of ticagrelor monotherapy after short-term DAPT, especially in patients with ACS. Methods Electronic databases were searched from inception to 11 November 2023, and for the primary analysis, individual patient data were pooled from the relevant randomized clinical trials comparing ticagrelor monotherapy after short-term (≤3 months) DAPT with ticagrelor-based 12-month DAPT, exclusively in ACS patients undergoing DES implantation. The co-primary endpoints were ischaemic endpoint (composite of all-cause death, myocardial infarction, or stroke) and bleeding endpoint [Bleeding Academic Research Consortium (BARC) type 3 or 5 bleeding] at 1 year. Results Individual patient data from two randomized clinical trials including 5906 ACS patients were analysed. At 1 year, the primary ischaemic endpoint did not differ between the ticagrelor monotherapy and ticagrelor-based DAPT groups [1.9% vs. 2.5%; adjusted hazard ratio (HR) 0.79; 95% confidence interval (CI) 0.56–1.13; P =.194]. The incidence of the primary bleeding endpoint was lower in the ticagrelor monotherapy group (2.4% vs. 4.5%; adjusted HR 0.54; 95% CI 0.40–0.72; P <.001). The results were consistent in a secondary aggregate data meta-analysis including the ACS subgroup of additional randomized clinical trials which enrolled patients with ACS as well as chronic coronary syndrome. Conclusions In ACS patients undergoing DES implantation, ticagrelor monotherapy after short-term DAPT was associated with less major bleeding without a concomitant increase in ischaemic events compared with ticagrelor-based 12-month DAPT. Study registration PROSPERO (ID: CRD42023476470).
- Subjects
ACUTE coronary syndrome; PLATELET aggregation inhibitors; MYOCARDIAL infarction; CLINICAL trials; TICAGRELOR
- Publication
European Heart Journal, 2024, Vol 45, Issue 33, p3045
- ISSN
0195-668X
- Publication type
Article
- DOI
10.1093/eurheartj/ehae249