Korean Circulation Journal

The Korean Society of Cardiology (대한심장학회)
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Ticagrelor Monotherapy After 3-Month Dual Antiplatelet Therapy in Acute Coronary Syndrome by High Bleeding Risk: The Subanalysis From the TICO Trial

  • Yong-Joon Lee (Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine) ;
  • Yongsung Suh (Division of Cardiology, Department of Internal Medicine, Myongji Hospital, Hanyang University College of Medicine) ;
  • Jung-Sun Kim (Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine) ;
  • Yun-Hyeong Cho (Division of Cardiology, Department of Internal Medicine, Myongji Hospital, Hanyang University College of Medicine) ;
  • Kyeong Ho Yun (Division of Cardiology, Wonkwang University Hospital) ;
  • Yong Hoon Kim (Division of Cardiology, Kangwon National University School of Medicine) ;
  • Jae Young Cho (Division of Cardiology, Wonkwang University Hospital) ;
  • Ae-Young Her (Division of Cardiology, Kangwon National University School of Medicine) ;
  • Sungsoo Cho (Division of Cardiology, Dankook University Hospital, Dankook University College of Medicine) ;
  • Dong Woon Jeon (Division of Cardiology, National Health Insurance Service Ilsan Hospital) ;
  • Sang-Yong Yoo (Division of Cardiology, Gangneung Asan Hospital, University of Ulsan College of Medicine) ;
  • Deok-Kyu Cho (Division of Cardiology, Yongin Severance Hospital, Yonsei University College of Medicine) ;
  • Bum-Kee Hong (Division of Cardiology, Gangnam Severance Hospital, Yonsei University College of Medicine) ;
  • Hyuckmoon Kwon (Division of Cardiology, Gangnam Severance Hospital, Yonsei University College of Medicine) ;
  • Sung-Jin Hong (Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine) ;
  • Chul-Min Ahn (Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine) ;
  • Dong-Ho Shin (Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine) ;
  • Chung-Mo Nam (Department of Preventive Medicine and Biostatistics, Yonsei University College of Medicine) ;
  • Byeong-Keuk Kim (Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine) ;
  • Young-Guk Ko (Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine) ;
  • Donghoon Choi (Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine) ;
  • Myeong-Ki Hong (Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine) ;
  • Yangsoo Jang (Division of Cardiology, CHA Bundang Medical Center, CHA University College of Medicine) ;
  • TICO investigators (TICO)
  • Received : 2021.09.24
  • Accepted : 2021.11.30
  • Published : 2022.04.01
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Abstract

Background and Objectives: Identifying patients with high bleeding risk (HBR) is important when making decisions for antiplatelet therapy strategy. This study evaluated the impact of ticagrelor monotherapy after 3-month dual antiplatelet therapy (DAPT) according to HBR in acute coronary syndrome (ACS) patients treated with drug eluting stents (DESs). Methods: In this post-hoc analysis of the TICO trial, HBR was defined by 2 approaches: meeting Academic Research Consortium for HBR (ARC-HBR) criteria or Predicting Bleeding Complications in Patients Undergoing Stent Implantation and Subsequent DAPT (PRECISE-DAPT) score ≥25. The primary outcome was a 3-12 months net adverse clinical event (composite of major bleeding and adverse cardiac and cerebrovascular events). Results: Of the 2,980 patients without adverse events during the first 3 months after DES implantation, 453 (15.2%) were HBR by ARC-HBR criteria and 504 (16.9%) were HBR by PRECISE-DAPT score. The primary outcome rate was higher in HBR versus non-HBR patients (by ARC-HBR criteria: hazard ratio [HR], 2.87; 95% confidence interval [CI], 1.76-4.69; p<0.001; by PRECISE-DAPT score: HR, 3.09; 95% CI, 1.92-4.98; p<0.001). Ticagrelor monotherapy after 3-month DAPT was associated with lower primary outcome rate than ticagrelor-based 12-month DAPT regardless of HBR by ARC-HBR criteria, with similar magnitudes of therapy effect for HBR and non-HBR patients (p-interaction=0.400). Results were consistent by PRECISE-DAPT score (p-interaction=0.178). Conclusions: In ACS patients treated with DESs, ticagrelor monotherapy after 3-month DAPT was associated with lower rate of adverse clinical outcomes regardless of HBR, with similar magnitudes of therapy effect between HBR and non-HBR.

Keywords

Acknowledgement

This work was supported by the Cardiovascular Research Center (Seoul, South Korea) and funded by Biotronik (Bulach, Switzerland).

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