P2Y12i monotherapy reduces net adverse clinical events in ACS patients undergoing PCI with DES

Ticagrelor With Or Without Aspirin In Acute Coronary Syndrome After Percutaneous Coronary Intervention: Randomized Evaluation Of Ticagrelor Monotherapy After 3-month Dual-antiplatelet Therapy In Acute Coronary Syndrome

Presented at ACC.20 by Yangsoo Jang, MD, PhD (Seoul, South Korea)

Introduction and methods

Dual antiplatelet therapy (DAPT) for 12 months with aspirin plus a P2Y12 inhibitor is currently recommended for patients with ACS undergoing PCI with drug-eluting stents (DES). The TICO trial investigated the effect of ticagrelor monotherapy after 3-months DAPT on net adverse clinical events (NACE), which combines the risks of ischemia and bleeding, compared with ticagrelor-based 12-month DAPT in patients with ACS undergoing PCI with a bioresorbable polymer sirolimus-eluting stent.

3,056 ACS patients who underwent PCI were randomized to receive either ticagrelor monotherapy after 3-months DAPT (3 months ticagrelor plus aspirin followed by 9 months ticagrelor monotherapy, n=1527) or conventional treatment (12 months ticagrelor plus aspirin, n=1529).

The primary endpoint was NACE, which was the composite of TIMI-major bleeding, and major adverse cardiac and cerebrovascular events (all cause death, MI, stent thrombosis, stroke, or target-vessel revascularization) at 12 months.

Main results

• The primary outcome of NACE occurred in 3.9% of patients in the ticagrelor monotherapy group and in 5.9% of patients in the conventional therapy group (HR 0.66, 95%CI 0.48-0.92, P=0.01).
• The difference in NACE between groups was mainly driven by a lower risk of TIMI major bleeding in the ticagrelor monotherapy group compared with the conventional therapy group (1.7% vs. 3.0%, HR 0.56, 95%CI 0.34-0.91, P=0.02).
• No statistically significant differences were found in major adverse cardiac and cerebrovascular events between groups (2.3% vs. 3.4%, HR 0.69, 95%CI 0.45-1.06, P=0.09).

Conclusion

Among patients with ACS who underwent PCI with DES, ticagrelor monotherapy after an initial 3-month treatment period with DAPT reduced the risk of NACE compared with 12 months ticagrelor-based DAPT. The lower risk of NACE in the ticagrelor monotherapy group was mainly driven by a reduced risk of major bleeding.

-Our coverage of ACC.20 is based on the information provided during the congress –