Key result
In patients with acute myocardial infarction and pre-procedural TIMI flow grade 2/3, 3-month dual antiplatelet therapy did not significantly reduce net adverse clinical events compared to 12-month therapy (HR 0.741), although 12-month therapy was associated with significantly higher bleeding rates.
Why the study?
The impact of pre-PCI TIMI flow grade on outcomes with 3-month versus 12-month DAPT in patients with AMI was evaluated.
Does 3-month DAPT reduce bleeding or ischemic events compared to 12-month DAPT in patients with acute myocardial infarction, stratified by pre-PCI TIMI flow grade?
RCT (n=2,083)
Open-label
1:1
Yes
Does 3-month DAPT reduce bleeding or ischemic events compared to 12-month DAPT in patients with acute myocardial infarction, stratified by pre-PCI TIMI flow grade?
Hazard Ratio: 0.741 (95% CI 0.432–1.273)
Absolute Event Rate: 4.9% vs 7.1%
p-value: p=0.278
In patients with AMI and pre-PCI TIMI flow grade 2/3, a 3-month DAPT strategy reduces bleeding without increasing MACCE compared to 12-month DAPT.
We investigated the impact of pre-percutaneous coronary intervention (pre-PCI) thrombolysis in myocardial infarction (TIMI) flow grade (pre-TIMI) on 3-month (3-mo) and 12-mo of dual antiplatelet therapy (DAPT) in patients with acute myocardial infarction (AMI). This was a post hoc analysis of the TICO trial. A total of 2083 patients with AMI (pre-TIMI 0/1: n = 1143; pre-TIMI 2/3: n = 940) were evaluated. The primary outcome was the occurrence of net adverse clinical events (NACE), defined as a composite of TIMI major bleeding and major adverse cardiac and cerebrovascular events (MACCE) within 12-mo following PCI. The secondary outcomes were the occurrence of the individual components of TIMI bleedings and MACCE. In the pre-TIMI 0/1 group, the primary and second outcomes were not significantly different between the 3-mo and 12-mo DAPT groups. However, in the pre-TIMI 2/3 group, the occurrences of TIMI minor (adjusted hazard ratio [aHR]: 0.294; p = 0.016) and major or minor bleeding (aHR: 0.483; p = 0.014) on intention-to-treat analysis were significantly higher in the 12-mo than in the 3-mo DAPT group. The occurrence of MACCE was similar between the two groups. A higher bleeding tendency in 12-mo DAPT compared with 3-mo DAPT was more obvious in the pre-TIMI 2/3 group than in the pre-TIMI 0/1 group.Clinical Trial Registration: URL: http://www.clinicaltrials.gov . Unique identifier: NCT02494895.
No takes yet. Share an insight, caveat, or question.
Kim et al. (2021) conducted an RCT in Acute myocardial infarction (AMI) (n=2,083). Ticagrelor monotherapy after 3-month DAPT vs. Ticagrelor-based 12-month DAPT was evaluated on Net adverse clinical events (NACE) in the pre-TIMI 2/3 group (aHR 0.741, 95% CI 0.432-1.273, p=0.278). In patients with acute myocardial infarction and pre-procedural TIMI flow grade 2/3, 3-month dual antiplatelet therapy did not significantly reduce net adverse clinical events compared to 12-month therapy (HR 0.741), although 12-month therapy was associated with significantly higher bleeding rates.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: