Ticagrelor monotherapy in ST-elevation myocardial infarction: An individual patient-level meta-analysis from TICO and T-PASS trials.

IF 12.8 Q1 MEDICINE, RESEARCH & EXPERIMENTAL

Med Pub Date : 2024-08-10 DOI:10.1016/j.medj.2024.07.019

Yong-Joon Lee, Deok-Kyu Cho, Jun-Won Lee, Sanghoon Shin, Sung Woo Kwon, Yongsung Suh, Tae Soo Kang, Jong-Kwan Park, Jang-Whan Bae, Woong Cheol Kang, Seunghwan Kim, Seung-Jun Lee, Sung-Jin Hong, Chul-Min Ahn, Jung-Sun Kim, Byeong-Keuk Kim, Young-Guk Ko, Donghoon Choi, Yangsoo Jang, Kyeong Ho Yun, Myeong-Ki Hong

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引用次数: 0

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).

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ST段抬高型心肌梗死的替卡格雷单药治疗：来自 TICO 和 T-PASS 试验的单个患者水平荟萃分析。

背景：在评估短期双联抗血小板疗法（DAPT）后强效P2Y12抑制剂单药治疗效果的随机临床试验中，ST段抬高型心肌梗死（STEMI）患者往往被排除在外或代表性不足：方法：从纳入接受药物洗脱支架（DES）植入术的 STEMI 患者的随机临床试验中汇集患者的个体数据，并比较短期（≤3 个月）DAPT 后替卡格雷单药治疗与基于替卡格雷的 12 个月 DAPT 在中央裁定的临床结果方面的差异。共同主要结果是1年的疗效结果（全因死亡、心肌梗死或中风的复合结果）和安全性结果（出血学术研究联合会3型或5型出血）：汇总队列中有2253名STEMI患者。替卡格雷单药治疗组与基于替卡格雷的DAPT治疗组的主要疗效结局发生率没有差异（1.8%对2.0%；危险比[HR]=0.88；95%置信区间[CI]=0.49-1.61；P=0.684）。两组间心脏性死亡的发生率没有差异（0.6% 对 0.7%；HR = 0.89；95% CI = 0.32-2.46；P = 0.822）。替卡格雷单药治疗组的主要安全性结局发生率显著较低（2.3%对4.0%；HR = 0.56；95% CI = 0.35-0.92；P = 0.020）。在不同亚组的主要结果中，未观察到治疗效果的异质性：结论：在接受DES植入治疗的STEMI患者中，与基于替卡格雷的12个月DAPT相比，短期DAPT后替卡格雷单药治疗与较低的大出血相关，且不会增加缺血事件的风险。有必要开展进一步研究，将这些发现推广到非亚洲患者：本研究由Biotronik公司（瑞士比拉赫）资助。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Med MEDICINE, RESEARCH & EXPERIMENTAL-

CiteScore

17.70

自引率

0.60%

发文量

102

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