Ticagrelor Monotherapy Versus Ticagrelor With Aspirin in Patients With ST-Segment Elevation Myocardial Infarction
Seung-Jun Lee1, Jae Young Cho2, Byeong-Keuk Kim1
1Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea.
Insights
Ticagrelor monotherapy after 3-month dual-antiplatelet therapy (DAPT) demonstrated consistent safety and efficacy across ST-segment elevation myocardial infarction (STEMI) and other acute coronary syndromes. This approach offers a reliable treatment strategy for post-myocardial infarction patients.
Area of Science:
- Cardiology
- Interventional Cardiology
- Pharmacology
Background:
- Ticagrelor monotherapy following short-term dual-antiplatelet therapy (DAPT) remains under-investigated in ST-segment elevation myocardial infarction (STEMI) patients.
- Understanding treatment consistency across acute coronary syndromes (ACS) is crucial for optimizing antiplatelet strategies.
Purpose of the Study:
- To evaluate the consistency of ticagrelor monotherapy's effects after 3-month DAPT in patients with STEMI, non-STEMI, and unstable angina treated with drug-eluting stents.
- To compare the efficacy and safety of ticagrelor monotherapy versus 12-month DAPT across different ACS presentations.
Main Methods:
- A pre-specified, stratified subgroup analysis of the STEMI cohort from the TICO trial.
- Primary outcome: composite of major bleeding and major adverse cardiac and cerebrovascular events (MACCE).
- Secondary outcomes: major bleeding and MACCE separately.
Main Results:
- The primary outcome incidence was similar across STEMI (4.4%), non-STEMI (6.0%), and unstable angina (4.1%) groups (p=0.09).
- Ticagrelor monotherapy after 3-month DAPT showed consistent effects on the primary outcome (pint=0.64), major bleeding (pint=0.36), and MACCE (pint=0.14) across clinical presentations.
- No increased risk of MACCE was observed with ticagrelor monotherapy in STEMI patients.
Conclusions:
- Ticagrelor monotherapy after 3-month DAPT exhibits consistent effects on major adverse cardiac and cerebrovascular events and bleeding across STEMI, non-STEMI, and unstable angina.
- Findings suggest consistent efficacy and safety, but larger studies are needed for definitive conclusions and adequate statistical power.
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).
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