Coronary disease & ACSSecondary analysis
Dual Antiplatelet Therapy De-Escalation in Stabilized Myocardial Infarction With High Ischemic Risk
- Post hoc analysis of the TALOS-AMI randomised trial
- open-label
- assessor-blinded
- multicenter
- post hoc subgroup analysis
Authors' conclusion
In stabilized patients with AMI, the ischemic and bleeding outcomes of an unguided de-escalation strategy with clopidogrel compared with a ticagrelor-based DAPT strategy were consistent without significant interaction, regardless of the presence of high ischemic risk.
Study context
- Population
- Stabilized patients with acute myocardial infarction (AMI) without events during 1 month of ticagrelor-based dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI); high ischemic risk = DM or CKD, multivessel PCI, ≥3 lesions, stent length >60 mm, ≥3 stents, left main PCI or bifurcation PCI with ≥2 stents1,371 high ischemic risk
- Participants
- 2,697 patients
- Comparison
- De-escalation vs Ticagrelor-based DAPT
- Primary endpoint
- Ischemic outcomes (CV death, MI, ischemic stroke, ischemia-driven revascularization or stent thrombosis) and bleeding outcomes (BARC type 2, 3 or 5)
Primary result
As reported in the abstract
Ischemic outcomes, by high ischemic risk
De-escalation vs Ticagrelor-based DAPTHazard ratio (95% CI)P value
high ischemic risk (684 vs 687)
0.88(0.54–1.45)
P = 0.62non-high ischemic risk (665 vs 661)
0.65(0.33–1.28)
P = 0.21Further findings
| Outcome | HR (95% CI) | P value | |
|---|---|---|---|
| Ischemic outcomes, high vs non-high ischemic risk | 1.74 (1.15–2.63) | P = 0.01 | |
| 0.20.5125Hazard ratio (log scale) |
Safety
| Outcome | HR (95% CI) | P value | |
|---|---|---|---|
| Bleeding (BARC type 2, 3 or 5), by high ischemic risk — De-escalation vs Ticagrelor-based DAPT · high ischemic risk | 0.64 (0.37–1.11) | P = 0.11 | |
| Bleeding (BARC type 2, 3 or 5), by high ischemic risk — De-escalation vs Ticagrelor-based DAPT · non-high ischemic risk | 0.42 (0.24–0.75) | P = 0.003 | |
| 0.20.5125Hazard ratio (log scale) |
- Bleeding (BARC type 2, 3 or 5), by high ischemic risk: P for interaction = .32
Original publication
Dual Antiplatelet Therapy De-Escalation in Stabilized Myocardial Infarction With High Ischemic Risk. JAMA Cardiol. Published 1 February 2024. doi:10.1001/jamacardio.2023.4587
Summarised from the published abstract; every number is checked against it