• Title/Summary/Keyword: Cardiology

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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;Yongsung Suh;Jung-Sun Kim;Yun-Hyeong Cho;Kyeong Ho Yun;Yong Hoon Kim;Jae Young Cho;Ae-Young Her;Sungsoo Cho;Dong Woon Jeon;Sang-Yong Yoo;Deok-Kyu Cho;Bum-Kee Hong;Hyuckmoon Kwon;Sung-Jin Hong;Chul-Min Ahn;Dong-Ho Shin;Chung-Mo Nam;Byeong-Keuk Kim;Young-Guk Ko;Donghoon Choi;Myeong-Ki Hong;Yangsoo Jang;TICO investigators
    • Korean Circulation Journal
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    • v.52 no.4
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    • pp.324-337
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    • 2022

  • 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.

  • https://doi.org/10.4070/kcj.2021.0321 인용 PDF

Discordance Between Angiographic Assessment and Fractional Flow Reserve or Intravascular Ultrasound in Intermediate Coronary Lesions: A Post-hoc Analysis of the FLAVOUR Trial

  • Jung-Hee Lee;Sung Gyun Ahn;Ho Sung Jeon;Jun-Won Lee;Young Jin Youn;Jinlong Zhang;Xinyang Hu;Jian'an Wang;Joo Myung Lee;Joo-Yong Hahn;Chang-Wook Nam;Joon-Hyung Doh;Bong-Ki Lee;Weon Kim;Jinyu Huang;Fan Jiang;Hao Zhou;Peng Chen;Lijiang Tang;Wenbing Jiang;Xiaomin Chen;Wenming He;Myeong-Ho Yoon;Seung-Jea Tahk;Ung Kim;You-Jeong Ki;Eun-Seok Shin;Doyeon Hwang;Jeehoon Kang;Hyo-Soo Kim;Bon-Kwon Koo
    • Korean Circulation Journal
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    • v.54 no.8
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    • pp.485-496
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    • 2024

  • Background and Objectives: Angiographic assessment of coronary stenosis severity using quantitative coronary angiography (QCA) is often inconsistent with that based on fractional flow reserve (FFR) or intravascular ultrasound (IVUS). We investigated the incidence of discrepancies between QCA and FFR or IVUS, and the outcomes of FFR- and IVUS-guided strategies in discordant coronary lesions. Methods: This study was a post-hoc analysis of the FLAVOUR study. We used a QCA-derived diameter stenosis (DS) of 60% or greater, the highest tertile, to classify coronary lesions as concordant or discordant with FFR or IVUS criteria for percutaneous coronary intervention (PCI). The patient-oriented composite outcome (POCO) was defined as a composite of death, myocardial infarction, or revascularization at 24 months. Results: The discordance rate between QCA and FFR or IVUS was 30.2% (n=551). The QCA-FFR discordance rate was numerically lower than the QCA-IVUS discordance rate (28.2% vs. 32.4%, p=0.050). In 200 patients with ≥60% DS, PCI was deferred according to negative FFR (n=141) and negative IVUS (n=59) (15.3% vs. 6.5%, p<0.001). The POCO incidence was comparable between the FFR- and IVUS-guided deferral strategies (5.9% vs. 3.4%, p=0.479). Conversely, 351 patients with DS <60% underwent PCI according to positive FFR (n=118) and positive IVUS (n=233) (12.8% vs. 25.9%, p<0.001). FFR- and IVUS-guided PCI did not differ in the incidence of POCO (9.5% vs. 6.5%, p=0.294). Conclusions: The proportion of QCA-FFR or IVUS discordance was approximately one third for intermediate coronary lesions. FFR- or IVUS-guided strategies for these lesions were comparable with respect to POCO at 24 months.

  • https://doi.org/10.4070/kcj.2024.0046 인용 PDF