Category Ranking
98%
Total Visits
921
Avg Visit Duration
2 minutes
Citations
20
Article Abstract
Background: Patients with ST-elevation myocardial infarction (STEMI) tend to be excluded or under-represented in randomized clinical trials evaluating the effects of potent P2Y12 inhibitor monotherapy after short-term dual antiplatelet therapy (DAPT).
Methods: Individual patient data were pooled from randomized clinical trials that included STEMI patients undergoing drug-eluting stent (DES) implantation and compared ticagrelor monotherapy after short-term (≤3 months) DAPT versus ticagrelor-based 12-month DAPT in terms of centrally adjudicated clinical outcomes. The co-primary outcomes were efficacy outcome (composite of all-cause death, myocardial infarction, or stroke) and safety outcome (Bleeding Academic Research Consortium type 3 or 5 bleeding) at 1 year.
Findings: The pooled cohort contained 2,253 patients with STEMI. The incidence of the primary efficacy outcome did not differ between the ticagrelor monotherapy group and the ticagrelor-based DAPT group (1.8% versus 2.0%; hazard ratio [HR] = 0.88; 95% confidence interval [CI] = 0.49-1.61; p = 0.684). There was no difference in cardiac death between the groups (0.6% versus 0.7%; HR = 0.89; 95% CI = 0.32-2.46; p = 0.822). The incidence of the primary safety outcome was significantly lower in the ticagrelor monotherapy group (2.3% versus 4.0%; HR = 0.56; 95% CI = 0.35-0.92; p = 0.020). No heterogeneity of treatment effects was observed for the primary outcomes across subgroups.
Conclusions: In patients with STEMI treated with DES implantation, ticagrelor monotherapy after short-term DAPT was associated with lower major bleeding without an increase in the risk of ischemic events compared with ticagrelor-based 12-month DAPT. Further research is necessary to extend these findings to non-Asian patients.
Funding: This study was funded by Biotronik (Bülach, Switzerland).
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1016/j.medj.2024.07.019 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Early Withdrawal of Aspirin after PCI in Acute Coronary Syndromes.
N Engl J Med
August 2025
Hospital Israelita Albert Einstein, São Paulo.
Background: Whether potent P2Y12 inhibitor monotherapy without aspirin initiated shortly after successful percutaneous coronary intervention (PCI) is effective and safe for patients with acute coronary syndromes is unclear.
Methods: We conducted a multicenter, open-label, randomized trial in Brazil involving patients with acute coronary syndromes who had undergone successful PCI. Patients were assigned in a 1:1 ratio within the first 4 days of hospitalization to stop treatment with aspirin and receive potent P2Y12 inhibitor monotherapy (ticagrelor or prasugrel) or to receive dual antiplatelet therapy (aspirin and a potent P2Y12 inhibitor) for 12 months.
Temporal modulation of antiplatelet therapy in high-risk patients undergoing complex percutaneous coronary intervention: the TAILORED-CHIP randomized clinical trial.
Eur Heart J
August 2025
Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea.
Background And Aims: Limited data exist on optimal antiplatelet strategies for high-risk patients undergoing complex percutaneous coronary intervention (PCI). This study aimed to investigate the efficacy and safety of tailored antiplatelet treatment with temporal modulation of the intensity of platelet inhibition in patients undergoing complex high-risk PCI.
Methods: We randomly assigned 2018 patients with high-risk anatomical or clinical characteristics undergoing complex PCI to a tailored antiplatelet strategy with early escalation (low-dose ticagrelor at 60 mg twice daily plus aspirin <6 months) and late de-escalation (clopidogrel monotherapy >6 months) or dual antiplatelet therapy (clopidogrel plus aspirin for 12 months).
Dual antiplatelet therapy (DAPT) is the standard approach for preventing ischemic events following percutaneous coronary intervention (PCI); however, the associated bleeding risk has led to growing interest in P2Y12 inhibitor monotherapy after an initial DAPT period. This systematic review evaluates the efficacy and safety of monotherapy with ticagrelor, clopidogrel, or prasugrel following one to three months of initial DAPT, compared to prolonged DAPT regimens. A comprehensive literature search was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, identifying randomized controlled trials (RCTs) and high-quality comparative studies published within the last five years.
View Article and Find Full Text PDFReal-world analysis of characteristics and guideline adherence of antiplatelet drugs prescriptions among patients with coronary artery disease and its comorbidities: a cross-sectional study.
BMC Cardiovasc Disord
August 2025
School of Public Health, Shanghai Jiaotong University School of Medicine, 227 Chongqing South RD, Shanghai, 200025, China.
Objectives: To identify the characteristics of antiplatelet drug (APD) prescriptions based on a regional large-scale outpatient database in Shanghai, China, and to compare the practical usage of APDs with the respective clinical guidelines for patients with coronary artery disease (CAD) in China.
Methods: Outpatient electronic healthcare records were extracted from 20 medical institutions in Shanghai from January 2020 to October 2021. Outpatient APD prescriptions among CAD patients and their comorbidity status were analyzed with the χ test.
Antiplatelet Monotherapies for Long-Term Secondary Prevention Following Percutaneous Coronary Intervention.
J Clin Med
August 2025
Division of Cardiology, University of Florida College of Medicine, Jacksonville, FL 32209, USA.
In patients with coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI), antiplatelet therapy is the cornerstone of treatment for secondary prevention. Although dual antiplatelet therapy (DAPT) consisting of aspirin and a P2Y inhibitor is the current standard of care, being, respectively, recommended for 6 and 12 months in patients with chronic and acute coronary syndrome without a need for oral anticoagulation, the continuous improvement in PCI technology and pharmacology have significantly reduced the need for long-term DAPT. Mounting evidence supports the administration of P2Y inhibitor monotherapy, particularly ticagrelor, after a short period of DAPT following PCI as a strategy to reduce bleeding without a trade-off in ischemic events compared to standard DAPT.
View Article and Find Full Text PDF