The Official Journal of EuroPCR and the European Association of Percutaneous Coronary Interventions (EAPCI)

A Prospective, Multicenter, Randomized, Open-label Trial to Compare Efficacy and Safety of Clopidogrel vs. Ticagrelor in Stabilized Patients with Acute Myocardial Infarction after Percutan eous Coronary Intervention: rationale and design of the TALOS-AMI trial

DOI: 10.4244/EIJ-D-20-00187

1. Department of Cardiology, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
2. Department of Cardiology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
3. Department of Cardiology, Cardiovascular Center, Chonnam National University Hospital, Gwangju, Republic of Korea
4. Department of Cardiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea, Korea, Republic Of
5. Department of Cardiology, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
6. Department of Cardiology, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
7. Department of Cardiology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
8. Department of Cardiology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Aims In patients undergoing percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI), the risk of ischemic complications is highest in early phase (during the first 30days), while most bleeding events predominantly occur during maintenance phase of treatment (after the first 30days). Data on the de-escalating dual antiplatelet therapy of switching from ticagrelor to clopidogrel in stabilized AMI patients are limited.
Methods and results The TALOS-AMI is a, multicenter, randomized, open-label study enrolling 2590 AMI patients with no adverse events during the first month after the index PCI. One month after the index PCI, eligible patients are randomly assigned either to the 1) aspirin 100 mg plus clopidogrel 75mg daily or 2) aspirin 100 mg plus ticagrelor 90 mg twice daily in a 1:1 ratio. The primary endpoint is a composite of cardiovascular death, MI, stroke, and bleeding type 2, 3 or 5 according to Bleeding Academic Research Consortium (BARC) criteria from 1 to 12 months after the index PCI.
Conclusions The TALOS-AMI trial is the first large-scale, multicenter, randomized study exploring the efficacy and safety of the de-escalating antiplatelet therapy that switches ticagrelor to clopidogrel in stabilized AMI patients undergoing PCI. 

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