医学
替卡格雷
传统PCI
氯吡格雷
经皮冠状动脉介入治疗
心肌梗塞
内科学
心脏病学
冲程(发动机)
支架
机械工程
工程类
作者
Myunhee Lee,Sungwook Byun,Soo Min Lim,Eun Ho Choo,Kwan Yong Lee,Dong Eon Moon,Ik Jun Choi,Byung‐Hee Hwang,Chan Joon Kim,Mahn‐Won Park,Yun Seok Choi,Hee-Yeol Kim,Ki‐Dong Yoo,Doo‐Soo Jeon,Hyeon Woo Yim,Kiyuk Chang,Myung Ho Jeong,Chul‐Soo Park,Woo Seung Shin,Dong‐Bin Kim,Sang Seol Jung,Byung Ryeol Cho,Jea Seung Ko,Won Kim,Seung Ho Huh,Ki Sik Kim,Sang Hyeon Kim,Chang Hyeon Cho,Sang‐Ho Park,Myung Ho Yoon,Jong Sun Park,Kyung Min Park,Seoung Hwan Lee,Kyung Tae Chung,Joon Ho Hyeong,Sang Wook Kim,Ji Yeon Baek,Bong Suk Shim,Ki Chul Sung,Joo Young Oh,Kwang Soo,Yong‐Hoon Cho,Jae‐Sik Jang,Jin Man Cho,Jang Hoon Lee
出处
期刊:JAMA Cardiology
[American Medical Association]
日期:2024-02-01
卷期号:9 (2): 125-125
标识
DOI:10.1001/jamacardio.2023.4587
摘要
In patients with acute myocardial infarction (AMI) who have high ischemic risk, data on the efficacy and safety of the de-escalation strategy of switching from ticagrelor to clopidogrel are lacking.To evaluate the outcomes of the de-escalation strategy compared with dual antiplatelet therapy (DAPT) with ticagrelor in stabilized patients with AMI and high ischemic risk following percutaneous coronary intervention (PCI).This was a post hoc analysis of the Ticagrelor vs Clopidogrel in Stabilized Patients With Acute Myocardial Infarction (TALOS-AMI) trial, an open-label, assessor-blinded, multicenter, randomized clinical trial. Patients with AMI who had no event during 1 month of ticagrelor-based DAPT after PCI were included. High ischemic risk was defined as having a history of diabetes or chronic kidney disease, multivessel PCI, at least 3 lesions treated, total stent length greater than 60 mm, at least 3 stents implanted, left main PCI, or bifurcation PCI with at least 2 stents. Data were collected from February 14, 2014, to January 21, 2021, and analyzed from December 1, 2021, to June 30, 2022.Patients were randomly assigned to either de-escalation from ticagrelor to clopidogrel or ticagrelor-based DAPT.Ischemic outcomes (composite of cardiovascular death, myocardial infarction, ischemic stroke, ischemia-driven revascularization, or stent thrombosis) and bleeding outcomes (Bleeding Academic Research Consortium type 2, 3, or 5 bleeding) were evaluated.Of 2697 patients with AMI (mean [SD] age, 60.0 [11.4] years; 454 [16.8%] female), 1371 (50.8%; 684 assigned to de-escalation and 687 assigned to ticagrelor-based DAPT) had high ischemic risk features and a significantly higher risk of ischemic outcomes than those without high ischemic risk (1326 patients [49.2%], including 665 assigned to de-escalation and 661 assigned to ticagrelor-based DAPT) (hazard ratio [HR], 1.74; 95% CI, 1.15-2.63; P = .01). De-escalation to clopidogrel, compared with ticagrelor-based DAPT, showed no significant difference in ischemic risk across the high ischemic risk group (HR, 0.88; 95% CI, 0.54-1.45; P = .62) and the non-high ischemic risk group (HR, 0.65; 95% CI, 0.33-1.28; P = .21), without heterogeneity (P for interaction = .47). The bleeding risk of the de-escalation group was consistent in both the high ischemic risk group (HR, 0.64; 95% CI, 0.37-1.11; P = .11) and the non-high ischemic risk group (HR, 0.42; 95% CI, 0.24-0.75; P = .003), without heterogeneity (P for interaction = .32).In stabilized patients with AMI, the ischemic and bleeding outcomes of an unguided de-escalation strategy with clopidogrel compared with a ticagrelor-based DAPT strategy were consistent without significant interaction, regardless of the presence of high ischemic risk.