De-escalation from ticagrelor to clopidogrel in patients with acute myocardial infarction: the TALOS-AMI HBR substudy

DOI: 10.4244/EIJ-D-23-00427

Min Chul Kim
Min Chul Kim1, MD, PhD; Sung Gyun Ahn2, MD, PhD; Kyung Hoon Cho1, MD, PhD; Doo Sun Sim1, MD, PhD; Young Joon Hong1, MD, PhD; Ju Han Kim1, MD, PhD; Myung Ho Jeong1, MD, PhD; Jun-Won Lee2, MD, PhD; Young-Jin Youn2, MD, PhD; Hee-Yeol Kim3, MD, PhD; Ki-Dong Yoo4, MD, PhD; Doo-Soo Jeon5, MD, PhD; Eun-Seok Shin6, MD, PhD; Young-Hoon Jeong7, MD, PhD; Kiyuk Chang8, MD, PhD; Youngkeun Ahn1, MD, PhD
1. Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, South Korea; 2. Division of Cardiology, Department of Internal Medicine, Wonju Severance Christian Hospital, Wonju, South Korea; 3. Division of Cardiology, Department of Internal Medicine, Bucheon St Mary’s Hospital, Bucheon, South Korea; 4. Division of Cardiology, Department of Internal Medicine, The Catholic University of Korea, St Vincent’s Hospital, Suwon, South Korea; 5. Division of Cardiology, Department of Internal Medicine, Incheon St Mary’s Hospital, Incheon, South Korea; 6. Division of Cardiology, Department of Internal Medicine, Ulsan University Hospital, Ulsan, South Korea; 7. Division of Cardiology, Department of Internal Medicine, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, South Korea; 8. Division of Cardiology, Department of Internal Medicine, The Catholic University of Korea, Seoul St Mary’s Hospital, Seoul, South Korea

Background: The benefits of de-escalation of P2Y12 inhibition after percutaneous coronary intervention (PCI) may differ by high bleeding risk (HBR) status.

Aims: We investigated the efficacy and safety of de-escalation from ticagrelor to clopidogrel after PCI by HBR status.

Methods: This is a non-prespecified post hoc analysis of the TicAgrelor Versus CLOpidogrel in Stabilized Patients with Acute Myocardial Infarction (TALOS-AMI) trial. Net adverse clinical events (a composite of cardiovascular death, myocardial infarction, stroke, or Bleeding Academic Research Consortium [BARC] bleeding type 2, 3, or 5) at 1 year post-PCI were compared between the de-escalation (clopidogrel plus aspirin) and the active control (ticagrelor plus aspirin) groups by HBR status, as defined by the modification of the Academic Research Consortium (ARC) criteria.

Results: A total of 2,625 patients in the TALOS-AMI trial were analysed. Of these, 589 (22.4%) met the modified ARC-HBR criteria. The de-escalation group had lower primary endpoint rates than the control group in both HBR (hazard ratio [HR] 0.47, 95% confidence interval [CI]: 0.26-0.84) and non-HBR (HR 0.59, 95% CI: 0.41-0.84) patients. There were no differences in treatment effect for the primary endpoint regardless of HBR status (p for interaction=0.904). BARC bleeding type 3 or 5 was less common in the de-escalation than the control group among HBR patients only (HR 0.24, 95% CI: 0.07-0.84).

Conclusions: In stabilised acute myocardial infarction patients, unguided de-escalation from ticagrelor to clopidogrel was associated with a lower rate of net adverse clinical outcomes irrespective of HBR status. The effect of de-escalation of P2Y12 inhibition on reducing haemorrhagic events was greater in patients with HBR.

Sign in to read and download the full article

Forgot your password?

No account yet?
Sign up for free!

Create my pcr account

Join us for free and access thousands of articles from EuroIntervention, as well as presentations, videos, cases from PCRonline.com

adjunctive pharmacotherapyclinical trialsnstemistemi
STEMINSTEMI
Read next article
A State-of-the-Art on cerebral embolic protection during transcatheter heart interventions; a debate on guided DAPT; the 3-year outcomes of the EuroCTO trial; the Myval device in non-calcified aortic regurgitation; timing of PCI in TAVI; alcohol-mediated RDN; distribution of renal nerves; and more

Latest news