A ticagrelor-based DAPT regimen was associated with higher 1-year NACCE compared to clopidogrel in ACS patients (7.8% vs 5.1%; HR 1.53, 95% CI 1.08-2.17), failing to show noninferiority (P=0.48).
Observational (n=2,062)
Does a ticagrelor-based DAPT regimen reduce net adverse clinical and cerebral events compared to a clopidogrel-based regimen in ACS patients treated with newer-generation DES?
In real-world ACS patients treated with newer-generation DES, a guideline-recommended ticagrelor-based DAPT regimen was associated with higher rates of net adverse clinical events and major bleeding compared to a clopidogrel-based regimen.
Hazard Ratio: 1.53 (95% CI 1.08–2.17)
Absolute Event Rate: 7.8% vs 5.1%
p-value: p=0.02
AIMS: Acute coronary syndrome (ACS) guidelines have been changed, favouring more potent antiplatelet drugs. We aimed to evaluate the safety and efficacy of a ticagrelor- instead of a clopidogrel-based primary dual antiplatelet (DAPT) regimen in ACS patients treated with newer-generation drug-eluting stents (DES). METHODS AND RESULTS: CHANGE DAPT (clinicaltrials.gov: NCT03197298) assessed 2,062 consecutive real-world ACS patients, treated by percutaneous coronary intervention (PCI), the primary composite endpoint being net adverse clinical and cerebral events (NACCE: all-cause death, any myocardial infarction, stroke or major bleeding). In the clopidogrel (CP; December 2012-April 2014) and ticagrelor periods (TP; May 2014-August 2015), 1,009 and 1,053 patients were treated, respectively. TP patients were somewhat older, underwent fewer transfemoral procedures, and received fewer glycoprotein IIb/IIIa inhibitors. In the TP, the one-year NACCE rate was higher (5.1% vs. 7.8%; HR 1.53 95% CI: 1.08-2.17; p=0.02). Assessment of non-inferiority (pre-specified margin: 2.7%) was inconclusive (risk difference: 2.64 95% CI: 0.52-4.77; pnon-inferiority=0.48). TP patients had more major bleeding (1.2% vs. 2.7%; p=0.02) while there was no benefit in ischaemic endpoints. Propensity score-adjusted multivariate analysis confirmed higher NACCE (adj. HR 1.75 95% CI: 1.20-2.55; p=0.003) and major bleeding risks during TP (adj. HR 2.75 95% CI: 1.34-5.61; p=0.01). CONCLUSIONS: In this observational study, the guideline-recommended ticagrelor-based primary DAPT regimen was associated with an increased event risk in consecutive ACS patients treated with newer-generation DES.
Zocca et al. (Wed,) conducted a observational in Acute coronary syndrome (n=2,062). Ticagrelor-based primary DAPT regimen vs. Clopidogrel-based primary DAPT regimen was evaluated on Net adverse clinical and cerebral events (NACCE: all-cause death, any myocardial infarction, stroke or major bleeding) (HR 1.53, 95% CI 1.08-2.17, p=0.02). A ticagrelor-based DAPT regimen was associated with higher 1-year NACCE compared to clopidogrel in ACS patients (7.8% vs 5.1%; HR 1.53, 95% CI 1.08-2.17), failing to show noninferiority (P=0.48).