Key result
Ticagrelor monotherapy after 3-month DAPT reduced net adverse clinical events compared to 12-month DAPT in patients with acute coronary syndrome, with consistent effects regardless of body mass index (p for interaction = 0.61).
Why the study?
It remained uncertain whether the net clinical benefit of ticagrelor monotherapy after 3-month DAPT over 12-month DAPT in ACS patients depends on body mass index.
Does ticagrelor monotherapy after 3-month DAPT improve clinical outcomes compared to 12-month DAPT in patients with ACS regardless of BMI?
RCT (n=3,056)
1:1
Yes
Does ticagrelor monotherapy after 3-month DAPT improve clinical outcomes compared to 12-month DAPT in patients with ACS regardless of BMI?
Ticagrelor monotherapy after 3 months of DAPT provides consistent clinical benefits over 12-month DAPT in ACS patients, regardless of their body mass index.
Supports ticagrelor monotherapy after short DAPT across BMI strata in ACS; extends TICO findings with no treatment interaction.
Background Although ticagrelor monotherapy after 3-month dual antiplatelet therapy (DAPT) results in a significantly greater net clinical benefit over that with ticagrelor-based 12-month DAPT in patients with acute coronary syndrome (ACS), it remains uncertain whether this effect is dependent on body mass index (BMI). We aimed to evaluate the BMI-dependent effect of these treatment strategies on clinical outcomes. Methods This was a pre-specified subgroup analysis from the TICO trial (Ticagrelor Monotherapy After 3 Months in Patients Treated With New Generation Sirolimus-eluting Stent for Acute Coronary Syndrome), evaluating the interaction between BMI and treatment strategies for the primary outcome [composite of major bleeding and adverse cardiac and cerebrovascular events (MACCE): death, myocardial infarction, stent thrombosis, stroke, or target-vessel revascularization]. The secondary outcomes were major bleeding and MACCE. Results Based on a pre-specified BMI threshold of 25 kg/m 2 , 3,056 patients were stratified. Patients with BMI <25 kg/m 2 had a higher risk of primary and secondary outcomes than those with BMI ≥25 kg/m 2 . Regardless of the BMI subgroup, the effects of ticagrelor monotherapy after 3-month DAPT on the primary outcome ( p int = 0.61), major bleeding ( p int = 0.76), and MACCE ( p int = 0.80) were consistent without significant interaction compared with ticagrelor-based 12-month DAPT. The treatment effects according to the BMI quartiles and age, sex, and diabetic status were also consistent without significant interaction. Conclusion The BMI-dependent impact of ticagrelor monotherapy after 3-month DAPT compared with 12-month DAPT on clinical outcomes was not heterogeneous in patients with ACS. Clinical Trial Registration [ www.ClinicalTrials.gov ], identifier [NCT02494895].
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Kim et al. (2023) conducted an RCT in Acute coronary syndrome (ACS) (n=3,056). Ticagrelor monotherapy after 3-month DAPT vs. Ticagrelor-based 12-month DAPT was evaluated on Net adverse clinical event (composite of MACCE and major bleeding) in patients with BMI <25 kg/m2 (HR 0.63, 95% CI 0.42-0.94, p=0.024). Ticagrelor monotherapy after 3-month DAPT reduced net adverse clinical events compared to 12-month DAPT in patients with acute coronary syndrome, with consistent effects regardless of body mass index (p for interaction = 0.61).
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