Impact of body mass on P2Y12-inhibitor de-escalation in acute coronary syndromes—a substudy of the TROPICAL-ACS trial
Authors' conclusion
The strategy of guided dual antiplatelet therapy de-escalation was associated with a significant net clinical benefit in non-overweight patients, while the two strategies were equivalent in overweight patients.
Study context
- Population
- Acute coronary syndrome (ACS) patients after PCI, by overweight (BMI >25 kg/m²) vs non-overweight
- Comparison
- Guided de-escalation vs Prasugrel
- Primary endpoint
- Net clinical benefit (CV death, MI, stroke or Bleeding Academic Research Consortium (BARC) 2-5 bleeding)
- Follow-up
- 12 months
Primary result
As reported in the abstract
Net clinical benefit, by body mass
Guided de-escalation vs PrasugrelHazard ratio (95% CI)P value
Non-overweight
0.52(0.31–0.88)
P = 0.013Overweight; P-non-inferiority = 0.03
0.95(0.69–1.31)
P = 0.717Further findings
| Outcome | HR (95% CI) | P value | |
|---|---|---|---|
| Ischaemic events, by body mass (non-overweight vs overweight; subgroup) · 12 monthsDe-escalation vs Prasugrel · non-overweight | 0.47 (0.18–1.25) | P = 0.128 | |
| Ischaemic events, by body mass (non-overweight vs overweight; subgroup) · 12 monthsDe-escalation vs Prasugrel · overweight | 0.89 (0.53–1.50) | ||
| 0.20.5125Hazard ratio (log scale) |
- Ischaemic events, by body mass (non-overweight vs overweight; subgroup): P-interaction = 0.261
Safety
| Outcome | HR (95% CI) | P value | |
|---|---|---|---|
| Bleeding events, by body mass (non-overweight vs overweight; subgroup) · 12 monthsDe-escalation vs Prasugrel · non-overweight | 0.55 (0.30–1.03) | P = 0.057 | |
| Bleeding events, by body mass (non-overweight vs overweight; subgroup) · 12 monthsDe-escalation vs Prasugrel · overweight | 0.95 (0.64–1.41) | ||
| 0.20.5125Hazard ratio (log scale) |
- Bleeding events, by body mass (non-overweight vs overweight; subgroup): P-interaction = 0.147
Original publication
Impact of body mass on P2Y12-inhibitor de-escalation in acute coronary syndromes—a substudy of the TROPICAL-ACS trial. Eur Heart J Cardiovasc Pharmacother. Published 4 April 2023. doi:10.
Summarised from the published abstract; every number is checked against it