Ticagrelor monotherapy in ST-elevation myocardial infarction: An individual patient-level meta-analysis from TICO and T-PASS trials
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). Individual patient data were pooled from randomized clinical...
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| creator | Lee, Yong-Joon Cho, Deok-Kyu Lee, Jun-Won Shin, Sanghoon Kwon, Sung Woo Suh, Yongsung Kang, Tae Soo Park, Jong-Kwan Bae, Jang-Whan Kang, Woong Cheol Kim, Seunghwan Lee, Seung-Jun Hong, Sung-Jin Ahn, Chul-Min Kim, Jung-Sun Kim, Byeong-Keuk Ko, Young-Guk Choi, Donghoon Jang, Yangsoo Yun, Kyeong Ho Hong, Myeong-Ki |
| description | 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).
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.
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.
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.
This study was funded by Biotronik (Bülach, Switzerland).
[Display omitted]
•Patients with STEMI were identified from the TICO and T-PASS trials•Ticagrelor monotherapy after short-term DAPT reduced major bleeding•Ticagrelor monotherapy after short-term DAPT did not increase ischemic events
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). In this individual patient data meta-analysis from the TICO and T-PASS trials, Lee et al. investigated the effects of ticagrelor monotherapy after short-term (≤3 months) DAPT, especially in patients with STEMI. Ticagrelor monothera |
| doi_str_mv | 10.1016/j.medj.2024.07.019 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_3094046634</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S2666634024003015</els_id><sourcerecordid>3094046634</sourcerecordid><originalsourceid>FETCH-LOGICAL-c1523-a72d41995f2c557a575aea4f0137a8b248a1d6e742a4f3e875e13ccbfe4b9393</originalsourceid><addsrcrecordid>eNp9kE1rGzEQhkVpaEKSP9BD0bGX3epz5S29GJM0gUAK3rsYS7OtzO7KldYGn_PHI-O09NTTSPN-wDyEfOSs5ow3X7b1iH5bCyZUzUzNePuOXImmaapGKvb-n_cluc15yxgTmkveig_kUrZcS2XkFXnpgoOfCYeY6BinOP_CBLsjDRNddxUOeIA5xImOx-gg-QBDkXpI7rT9SpdT-fpwCH5flF3x4jRXJYUDHXGGCiYYjjlk2qc40u5x9Uxh8rSrfizXazqnUphvyEVfBt6-zWvS3d91q4fq6fn742r5VDmuhazACK942-peOK0NaKMBQfWMSwOLjVAL4L5Bo0RZSlwYjVw6t-lRbVrZymvy-Vy7S_H3HvNsx5AdDgNMGPfZStYqppqCrFjF2epSzDlhb3cpjJCOljN7wm-39oTfnvBbZmzBX0Kf3vr3myL-jfyBXQzfzgYsRx4CJptd4eXQh4Rutj6G__W_AiWGlyc</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>3094046634</pqid></control><display><type>article</type><title>Ticagrelor monotherapy in ST-elevation myocardial infarction: An individual patient-level meta-analysis from TICO and T-PASS trials</title><source>MEDLINE</source><source>Alma/SFX Local Collection</source><creator>Lee, Yong-Joon ; Cho, Deok-Kyu ; Lee, Jun-Won ; Shin, Sanghoon ; Kwon, Sung Woo ; Suh, Yongsung ; Kang, Tae Soo ; Park, Jong-Kwan ; Bae, Jang-Whan ; Kang, Woong Cheol ; Kim, Seunghwan ; Lee, Seung-Jun ; Hong, Sung-Jin ; Ahn, Chul-Min ; Kim, Jung-Sun ; Kim, Byeong-Keuk ; Ko, Young-Guk ; Choi, Donghoon ; Jang, Yangsoo ; Yun, Kyeong Ho ; Hong, Myeong-Ki</creator><creatorcontrib>Lee, Yong-Joon ; Cho, Deok-Kyu ; Lee, Jun-Won ; Shin, Sanghoon ; Kwon, Sung Woo ; Suh, Yongsung ; Kang, Tae Soo ; Park, Jong-Kwan ; Bae, Jang-Whan ; Kang, Woong Cheol ; Kim, Seunghwan ; Lee, Seung-Jun ; Hong, Sung-Jin ; Ahn, Chul-Min ; Kim, Jung-Sun ; Kim, Byeong-Keuk ; Ko, Young-Guk ; Choi, Donghoon ; Jang, Yangsoo ; Yun, Kyeong Ho ; Hong, Myeong-Ki</creatorcontrib><description>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).
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.
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.
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.
This study was funded by Biotronik (Bülach, Switzerland).
[Display omitted]
•Patients with STEMI were identified from the TICO and T-PASS trials•Ticagrelor monotherapy after short-term DAPT reduced major bleeding•Ticagrelor monotherapy after short-term DAPT did not increase ischemic events
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). In this individual patient data meta-analysis from the TICO and T-PASS trials, Lee et al. investigated the effects of ticagrelor monotherapy after short-term (≤3 months) DAPT, especially in patients with STEMI. Ticagrelor monotherapy was not associated with an increase in ischemic events, and it was associated with a significant reduction in major bleeding events, compared with ticagrelor-based 12-month DAPT. Their results suggest that ticagrelor monotherapy after short-term DAPT could be a feasible antiplatelet therapy approach even in patients with STEMI, who tend to be excluded or under-represented in randomized trials.
Individual patient data were obtained from the TICO and T-PASS trials. Lee et al. showed that in ST-elevation myocardial infarction patients undergoing drug-eluting stent implantation, ticagrelor monotherapy after short-term dual antiplatelet therapy (DAPT) reduced major bleeding without increasing ischemic events compared with ticagrelor-based 12-month DAPT.</description><identifier>ISSN: 2666-6340</identifier><identifier>EISSN: 2666-6340</identifier><identifier>DOI: 10.1016/j.medj.2024.07.019</identifier><identifier>PMID: 39153473</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Aged ; drug-eluting stent ; Drug-Eluting Stents ; Dual Anti-Platelet Therapy - methods ; dual antiplatelet therapy ; Female ; Hemorrhage - chemically induced ; Humans ; Male ; Middle Aged ; Percutaneous Coronary Intervention - methods ; Platelet Aggregation Inhibitors - administration & dosage ; Platelet Aggregation Inhibitors - adverse effects ; Platelet Aggregation Inhibitors - therapeutic use ; Purinergic P2Y Receptor Antagonists - administration & dosage ; Purinergic P2Y Receptor Antagonists - adverse effects ; Purinergic P2Y Receptor Antagonists - therapeutic use ; Randomized Controlled Trials as Topic ; ST Elevation Myocardial Infarction - drug therapy ; ST Elevation Myocardial Infarction - mortality ; ST Elevation Myocardial Infarction - therapy ; ST-elevation myocardial infarction ; ticagrelor ; Ticagrelor - administration & dosage ; Ticagrelor - adverse effects ; Ticagrelor - therapeutic use ; Treatment Outcome</subject><ispartof>Med (New York, N.Y. : Online), 2024-12, Vol.5 (12), p.1466-1474.e2</ispartof><rights>2024 Elsevier Inc.</rights><rights>Copyright © 2024 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c1523-a72d41995f2c557a575aea4f0137a8b248a1d6e742a4f3e875e13ccbfe4b9393</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/39153473$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Lee, Yong-Joon</creatorcontrib><creatorcontrib>Cho, Deok-Kyu</creatorcontrib><creatorcontrib>Lee, Jun-Won</creatorcontrib><creatorcontrib>Shin, Sanghoon</creatorcontrib><creatorcontrib>Kwon, Sung Woo</creatorcontrib><creatorcontrib>Suh, Yongsung</creatorcontrib><creatorcontrib>Kang, Tae Soo</creatorcontrib><creatorcontrib>Park, Jong-Kwan</creatorcontrib><creatorcontrib>Bae, Jang-Whan</creatorcontrib><creatorcontrib>Kang, Woong Cheol</creatorcontrib><creatorcontrib>Kim, Seunghwan</creatorcontrib><creatorcontrib>Lee, Seung-Jun</creatorcontrib><creatorcontrib>Hong, Sung-Jin</creatorcontrib><creatorcontrib>Ahn, Chul-Min</creatorcontrib><creatorcontrib>Kim, Jung-Sun</creatorcontrib><creatorcontrib>Kim, Byeong-Keuk</creatorcontrib><creatorcontrib>Ko, Young-Guk</creatorcontrib><creatorcontrib>Choi, Donghoon</creatorcontrib><creatorcontrib>Jang, Yangsoo</creatorcontrib><creatorcontrib>Yun, Kyeong Ho</creatorcontrib><creatorcontrib>Hong, Myeong-Ki</creatorcontrib><title>Ticagrelor monotherapy in ST-elevation myocardial infarction: An individual patient-level meta-analysis from TICO and T-PASS trials</title><title>Med (New York, N.Y. : Online)</title><addtitle>Med</addtitle><description>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).
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.
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.
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.
This study was funded by Biotronik (Bülach, Switzerland).
[Display omitted]
•Patients with STEMI were identified from the TICO and T-PASS trials•Ticagrelor monotherapy after short-term DAPT reduced major bleeding•Ticagrelor monotherapy after short-term DAPT did not increase ischemic events
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). In this individual patient data meta-analysis from the TICO and T-PASS trials, Lee et al. investigated the effects of ticagrelor monotherapy after short-term (≤3 months) DAPT, especially in patients with STEMI. Ticagrelor monotherapy was not associated with an increase in ischemic events, and it was associated with a significant reduction in major bleeding events, compared with ticagrelor-based 12-month DAPT. Their results suggest that ticagrelor monotherapy after short-term DAPT could be a feasible antiplatelet therapy approach even in patients with STEMI, who tend to be excluded or under-represented in randomized trials.
Individual patient data were obtained from the TICO and T-PASS trials. Lee et al. showed that in ST-elevation myocardial infarction patients undergoing drug-eluting stent implantation, ticagrelor monotherapy after short-term dual antiplatelet therapy (DAPT) reduced major bleeding without increasing ischemic events compared with ticagrelor-based 12-month DAPT.</description><subject>Aged</subject><subject>drug-eluting stent</subject><subject>Drug-Eluting Stents</subject><subject>Dual Anti-Platelet Therapy - methods</subject><subject>dual antiplatelet therapy</subject><subject>Female</subject><subject>Hemorrhage - chemically induced</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Percutaneous Coronary Intervention - methods</subject><subject>Platelet Aggregation Inhibitors - administration & dosage</subject><subject>Platelet Aggregation Inhibitors - adverse effects</subject><subject>Platelet Aggregation Inhibitors - therapeutic use</subject><subject>Purinergic P2Y Receptor Antagonists - administration & dosage</subject><subject>Purinergic P2Y Receptor Antagonists - adverse effects</subject><subject>Purinergic P2Y Receptor Antagonists - therapeutic use</subject><subject>Randomized Controlled Trials as Topic</subject><subject>ST Elevation Myocardial Infarction - drug therapy</subject><subject>ST Elevation Myocardial Infarction - mortality</subject><subject>ST Elevation Myocardial Infarction - therapy</subject><subject>ST-elevation myocardial infarction</subject><subject>ticagrelor</subject><subject>Ticagrelor - administration & dosage</subject><subject>Ticagrelor - adverse effects</subject><subject>Ticagrelor - therapeutic use</subject><subject>Treatment Outcome</subject><issn>2666-6340</issn><issn>2666-6340</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kE1rGzEQhkVpaEKSP9BD0bGX3epz5S29GJM0gUAK3rsYS7OtzO7KldYGn_PHI-O09NTTSPN-wDyEfOSs5ow3X7b1iH5bCyZUzUzNePuOXImmaapGKvb-n_cluc15yxgTmkveig_kUrZcS2XkFXnpgoOfCYeY6BinOP_CBLsjDRNddxUOeIA5xImOx-gg-QBDkXpI7rT9SpdT-fpwCH5flF3x4jRXJYUDHXGGCiYYjjlk2qc40u5x9Uxh8rSrfizXazqnUphvyEVfBt6-zWvS3d91q4fq6fn742r5VDmuhazACK942-peOK0NaKMBQfWMSwOLjVAL4L5Bo0RZSlwYjVw6t-lRbVrZymvy-Vy7S_H3HvNsx5AdDgNMGPfZStYqppqCrFjF2epSzDlhb3cpjJCOljN7wm-39oTfnvBbZmzBX0Kf3vr3myL-jfyBXQzfzgYsRx4CJptd4eXQh4Rutj6G__W_AiWGlyc</recordid><startdate>20241213</startdate><enddate>20241213</enddate><creator>Lee, Yong-Joon</creator><creator>Cho, Deok-Kyu</creator><creator>Lee, Jun-Won</creator><creator>Shin, Sanghoon</creator><creator>Kwon, Sung Woo</creator><creator>Suh, Yongsung</creator><creator>Kang, Tae Soo</creator><creator>Park, Jong-Kwan</creator><creator>Bae, Jang-Whan</creator><creator>Kang, Woong Cheol</creator><creator>Kim, Seunghwan</creator><creator>Lee, Seung-Jun</creator><creator>Hong, Sung-Jin</creator><creator>Ahn, Chul-Min</creator><creator>Kim, Jung-Sun</creator><creator>Kim, Byeong-Keuk</creator><creator>Ko, Young-Guk</creator><creator>Choi, Donghoon</creator><creator>Jang, Yangsoo</creator><creator>Yun, Kyeong Ho</creator><creator>Hong, Myeong-Ki</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20241213</creationdate><title>Ticagrelor monotherapy in ST-elevation myocardial infarction: An individual patient-level meta-analysis from TICO and T-PASS trials</title><author>Lee, Yong-Joon ; Cho, Deok-Kyu ; Lee, Jun-Won ; Shin, Sanghoon ; Kwon, Sung Woo ; Suh, Yongsung ; Kang, Tae Soo ; Park, Jong-Kwan ; Bae, Jang-Whan ; Kang, Woong Cheol ; Kim, Seunghwan ; Lee, Seung-Jun ; Hong, Sung-Jin ; Ahn, Chul-Min ; Kim, Jung-Sun ; Kim, Byeong-Keuk ; Ko, Young-Guk ; Choi, Donghoon ; Jang, Yangsoo ; Yun, Kyeong Ho ; Hong, Myeong-Ki</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c1523-a72d41995f2c557a575aea4f0137a8b248a1d6e742a4f3e875e13ccbfe4b9393</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Aged</topic><topic>drug-eluting stent</topic><topic>Drug-Eluting Stents</topic><topic>Dual Anti-Platelet Therapy - methods</topic><topic>dual antiplatelet therapy</topic><topic>Female</topic><topic>Hemorrhage - chemically induced</topic><topic>Humans</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Percutaneous Coronary Intervention - methods</topic><topic>Platelet Aggregation Inhibitors - administration & dosage</topic><topic>Platelet Aggregation Inhibitors - adverse effects</topic><topic>Platelet Aggregation Inhibitors - therapeutic use</topic><topic>Purinergic P2Y Receptor Antagonists - administration & dosage</topic><topic>Purinergic P2Y Receptor Antagonists - adverse effects</topic><topic>Purinergic P2Y Receptor Antagonists - therapeutic use</topic><topic>Randomized Controlled Trials as Topic</topic><topic>ST Elevation Myocardial Infarction - drug therapy</topic><topic>ST Elevation Myocardial Infarction - mortality</topic><topic>ST Elevation Myocardial Infarction - therapy</topic><topic>ST-elevation myocardial infarction</topic><topic>ticagrelor</topic><topic>Ticagrelor - administration & dosage</topic><topic>Ticagrelor - adverse effects</topic><topic>Ticagrelor - therapeutic use</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Lee, Yong-Joon</creatorcontrib><creatorcontrib>Cho, Deok-Kyu</creatorcontrib><creatorcontrib>Lee, Jun-Won</creatorcontrib><creatorcontrib>Shin, Sanghoon</creatorcontrib><creatorcontrib>Kwon, Sung Woo</creatorcontrib><creatorcontrib>Suh, Yongsung</creatorcontrib><creatorcontrib>Kang, Tae Soo</creatorcontrib><creatorcontrib>Park, Jong-Kwan</creatorcontrib><creatorcontrib>Bae, Jang-Whan</creatorcontrib><creatorcontrib>Kang, Woong Cheol</creatorcontrib><creatorcontrib>Kim, Seunghwan</creatorcontrib><creatorcontrib>Lee, Seung-Jun</creatorcontrib><creatorcontrib>Hong, Sung-Jin</creatorcontrib><creatorcontrib>Ahn, Chul-Min</creatorcontrib><creatorcontrib>Kim, Jung-Sun</creatorcontrib><creatorcontrib>Kim, Byeong-Keuk</creatorcontrib><creatorcontrib>Ko, Young-Guk</creatorcontrib><creatorcontrib>Choi, Donghoon</creatorcontrib><creatorcontrib>Jang, Yangsoo</creatorcontrib><creatorcontrib>Yun, Kyeong Ho</creatorcontrib><creatorcontrib>Hong, Myeong-Ki</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Med (New York, N.Y. : Online)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Lee, Yong-Joon</au><au>Cho, Deok-Kyu</au><au>Lee, Jun-Won</au><au>Shin, Sanghoon</au><au>Kwon, Sung Woo</au><au>Suh, Yongsung</au><au>Kang, Tae Soo</au><au>Park, Jong-Kwan</au><au>Bae, Jang-Whan</au><au>Kang, Woong Cheol</au><au>Kim, Seunghwan</au><au>Lee, Seung-Jun</au><au>Hong, Sung-Jin</au><au>Ahn, Chul-Min</au><au>Kim, Jung-Sun</au><au>Kim, Byeong-Keuk</au><au>Ko, Young-Guk</au><au>Choi, Donghoon</au><au>Jang, Yangsoo</au><au>Yun, Kyeong Ho</au><au>Hong, Myeong-Ki</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Ticagrelor monotherapy in ST-elevation myocardial infarction: An individual patient-level meta-analysis from TICO and T-PASS trials</atitle><jtitle>Med (New York, N.Y. : Online)</jtitle><addtitle>Med</addtitle><date>2024-12-13</date><risdate>2024</risdate><volume>5</volume><issue>12</issue><spage>1466</spage><epage>1474.e2</epage><pages>1466-1474.e2</pages><issn>2666-6340</issn><eissn>2666-6340</eissn><abstract>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).
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.
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.
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.
This study was funded by Biotronik (Bülach, Switzerland).
[Display omitted]
•Patients with STEMI were identified from the TICO and T-PASS trials•Ticagrelor monotherapy after short-term DAPT reduced major bleeding•Ticagrelor monotherapy after short-term DAPT did not increase ischemic events
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). In this individual patient data meta-analysis from the TICO and T-PASS trials, Lee et al. investigated the effects of ticagrelor monotherapy after short-term (≤3 months) DAPT, especially in patients with STEMI. Ticagrelor monotherapy was not associated with an increase in ischemic events, and it was associated with a significant reduction in major bleeding events, compared with ticagrelor-based 12-month DAPT. Their results suggest that ticagrelor monotherapy after short-term DAPT could be a feasible antiplatelet therapy approach even in patients with STEMI, who tend to be excluded or under-represented in randomized trials.
Individual patient data were obtained from the TICO and T-PASS trials. Lee et al. showed that in ST-elevation myocardial infarction patients undergoing drug-eluting stent implantation, ticagrelor monotherapy after short-term dual antiplatelet therapy (DAPT) reduced major bleeding without increasing ischemic events compared with ticagrelor-based 12-month DAPT.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>39153473</pmid><doi>10.1016/j.medj.2024.07.019</doi></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 2666-6340 |
| ispartof | Med (New York, N.Y. : Online), 2024-12, Vol.5 (12), p.1466-1474.e2 |
| issn | 2666-6340 2666-6340 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_3094046634 |
| source | MEDLINE; Alma/SFX Local Collection |
| subjects | Aged drug-eluting stent Drug-Eluting Stents Dual Anti-Platelet Therapy - methods dual antiplatelet therapy Female Hemorrhage - chemically induced Humans Male Middle Aged Percutaneous Coronary Intervention - methods Platelet Aggregation Inhibitors - administration & dosage Platelet Aggregation Inhibitors - adverse effects Platelet Aggregation Inhibitors - therapeutic use Purinergic P2Y Receptor Antagonists - administration & dosage Purinergic P2Y Receptor Antagonists - adverse effects Purinergic P2Y Receptor Antagonists - therapeutic use Randomized Controlled Trials as Topic ST Elevation Myocardial Infarction - drug therapy ST Elevation Myocardial Infarction - mortality ST Elevation Myocardial Infarction - therapy ST-elevation myocardial infarction ticagrelor Ticagrelor - administration & dosage Ticagrelor - adverse effects Ticagrelor - therapeutic use Treatment Outcome |
| title | Ticagrelor monotherapy in ST-elevation myocardial infarction: An individual patient-level meta-analysis from TICO and T-PASS trials |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-04T08%3A57%3A11IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Ticagrelor%20monotherapy%20in%20ST-elevation%20myocardial%20infarction:%20An%20individual%20patient-level%20meta-analysis%20from%20TICO%20and%20T-PASS%20trials&rft.jtitle=Med%20(New%20York,%20N.Y.%20:%20Online)&rft.au=Lee,%20Yong-Joon&rft.date=2024-12-13&rft.volume=5&rft.issue=12&rft.spage=1466&rft.epage=1474.e2&rft.pages=1466-1474.e2&rft.issn=2666-6340&rft.eissn=2666-6340&rft_id=info:doi/10.1016/j.medj.2024.07.019&rft_dat=%3Cproquest_cross%3E3094046634%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=3094046634&rft_id=info:pmid/39153473&rft_els_id=S2666634024003015&rfr_iscdi=true |