Key result
Aspirin plus ticagrelor reduces subclinical stent thrombosis vs aspirin plus clopidogrel in second-generation DES.
Why the study?
The study was designed to evaluate the benefits of ticagrelor over clopidogrel in reducing subclinical stent thrombosis after second-generation DES implantation.
Does aspirin plus ticagrelor reduce subclinical stent thrombosis detected by OCT in patients with single de novo coronary stenosis undergoing second-generation DES implantation compared to aspirin plus clopidogrel?
RCT (n=352)
Yes
Does aspirin plus ticagrelor reduce subclinical stent thrombosis detected by OCT in patients with single de novo coronary stenosis undergoing second-generation DES implantation compared to aspirin plus clopidogrel?
p-value: p=< .05
Ticagrelor plus aspirin significantly reduces subclinical stent thrombosis detected by OCT at 1 year compared to clopidogrel plus aspirin in patients receiving second-generation DES.
Supports ticagrelor over clopidogrel to reduce OCT-detected subclinical stent thrombosis after second-generation DES; extends mixed prior DAPT evidence.
Introduction: This prospective, multicenter, randomized study was designed to analyze the benefits of ticagrelor over clopidogrel in reducing subclinical stent thrombosis (ST) in patients with coronary artery disease who underwent implantation of a second-generation drug-eluting stent (DES).Methods: About 352 patients with single de novo coronary stenosis were randomly assigne`d to either clopidogrel group (aspirin plus clopidogrel) or ticagrelor group (aspirin plus ticagrelor) after DES implantation for 1 year. Baseline clinical characteristics, blood chemistry markers, coronary artery angiography (CAG), and optical coherence tomography (OCT) were obtained during the index procedure. Data about clinic, CAG and OCT were also collected after 1 year follow-up. Intention-to-treat (ITT), per protocol set (PPS), and sensitivity analysis of subclinical ST were performed. Major factors associated with subclinical ST were analyzed by multivariable and univariable logistic regression models.Results: The incidence of subclinical ST in ticagrelor group was significantly low as compared to clopidogrel group (P < .05) at 1-year follow-up. Ticagrelor use was an independent factor in reducing subclinical ST (P < .05). The percentage of endothelial coverage, neointimal hyperplasia, malapposition, and edge dissection about stents were not different between the two groups (P > .05). Bleeding ratio was not markedly altered after ticagrelor treatment (P > .05). Not any significant differences were detected with regard to baseline clinical characteristics, CAG results, and DES between ticagrelor and clopidogrel groups (P > .05).Conclusion: In patients who underwent a second-generation DES implantation, using aspirin plus ticagrelor was associated with a significant reduction in subclinical ST. (ClinicalTrials.gov.
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Wu et al. (2020) conducted an RCT in Coronary artery disease with single de novo coronary stenosis (n=352). Ticagrelor (aspirin plus ticagrelor) vs. Clopidogrel (aspirin plus clopidogrel) was evaluated on Subclinical stent thrombosis (ST) detected by optical coherence tomography (p=< .05). Aspirin plus ticagrelor significantly reduced the incidence of subclinical stent thrombosis at 1 year compared to aspirin plus clopidogrel in patients with a second-generation DES (P < .05).
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