Influence of early dose reduction of ticagrelor on clinical outcomes following percutaneous coronary intervention for complex lesions

Figures

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  Figure 1. Schematic description of the patient selection process. Among the 977 patients included in the study, 208 switched their DAPT regimens to those other than ticagrelor-based DAPT before 6 months of follow-up, 115 changed to low-dose ticagrelor-based DAPT and 657 remained on standard-dose ticagrelor-based DAPT at 6 months of follow-up. The median duration of standard-dose ticagrelor use was 179 (IQR, 99–198) days in the low-dose group and 371 (IQR, 347–404) days in the standard-dose group (p < 0.001).

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  Figure 2. DAPT regimen change patterns within 6 months. Among the 977 patients included in the study, 32.8% switched to regimens other than standard-dose ticagrelor-based DAPT, and the 2 most common regimens to change were prasugrel-based DAPT and low-dose ticargrelor-based DAPT. The 3 most common reasons for the regimen changes were physician preference, respiratory adverse events and bleeding. Physician preference was more frequent in the ticagrelor-based DAPT group, while respiratory adverse events were more frequent in the nonticagrelor-based DAPT group. SAPT, single antiplatelet agent therapy; DAPT, dual antiplatelet therapy.

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  Figure 3. Kaplan‒Meier survival analysis for MACEs, bleeding events and NACEs in the IPTW-applied cohort. The cumulative incidences of all clinical events were not significantly different between the standard-dose and low dose groups (A). Landmark analyses also showed that the cumulative incidences of all clinical events were not significantly different beyond 6 months after PCI (B). MACE, major adverse cardiovascular event; NACE, net adverse clinical event; PCI, percutaneous coronary intervention; DAPT, dual antiplatelet agent.

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  Figure 4. Time-varying survival curves of MACEs, bleeding events, and NACEs. A switching to low-dose ticagrelor-based DAPT occurred in 130 patients throughout the follow-up. A time-varying survival analysis showed that the cumulative incidences of MACE and NACE were not different between the standard-dose and low-dose groups, but bleeding was marginally more frequent in the low-dose group. MACE, major adverse cardiovascular event; NACE, net adverse clinical event; PCI, percutaneous coronary intervention.