Key result
De-escalation of P2Y12 inhibitor therapy to aspirin and clopidogrel was not associated with a higher risk of MACE (4.91 vs 4.72 per 100 person-years) compared to unchanged DAPT in AMI patients.
Why the study?
To evaluate the effect of de-escalating P2Y12 inhibitor therapy in DAPT on MACE and bleeding complications after AMI in Taiwanese patients undergoing PCI.
Does de-escalation of P2Y12 inhibitor therapy to aspirin and clopidogrel after 3 months of event-free treatment reduce MACE and bleeding in AMI patients undergoing PCI?
Cohort (n=10,100)
Yes
Does de-escalation of P2Y12 inhibitor therapy to aspirin and clopidogrel after 3 months of event-free treatment reduce MACE and bleeding in AMI patients undergoing PCI?
Absolute Event Rate: 4.91% vs 4.72%
Real-world data suggests that de-escalating DAPT from ticagrelor to clopidogrel after 3 months of event-free therapy in AMI patients post-PCI is safe and not associated with increased ischemic or bleeding risks.
De-escalation of P2Y12 inhibitors after AMI may balance ischemic and bleeding risks in selected patients; leaves open need for prospective RCTs.
To examine the effect of de-escalation of P2Y12 inhibitor in dual antiplatelet therapy (DAPT) on major adverse cardiovascular events (MACE) and bleeding complications after acute myocardial infarction (AMI) in Taiwanese patients undergoing percutaneous coronary intervention (PCI). Patients who had received PCI during hospitalization for AMI (between 2013 and 2016) and were initially treated with aspirin and ticagrelor and without adverse events after 3 months of treatment were retrospectively evaluated. In total, 1,901 and 8,199 patients were identified as "de-escalated DAPT" (switched to aspirin and clopidogrel) and "unchanged DAPT" (continued on aspirin and ticagrelor) cohorts, respectively. With a mean follow-up of 8 months, the incidence rates (per 100 person-year) of death, AMI readmission and MACE were 2.89, 3.68, and 4.91 in the de-escalated cohort and 2.42, 3.28, and 4.72 in the unchanged cohort, respectively, based on an inverse probability of treatment weighted approach that adjusting for baseline characteristics of the patients. Multivariate Cox regression analyses showed the two groups had no significant differences in the hazard risk of death, AMI admission, and MACE. Additionally, there was no observed difference in the risk of bleeding, including major or clinically relevant non-major bleeding. The real-world data revealed that de-escalation of P2Y12 inhibitor in DAPT was not associated with a higher risk of death or AMI readmission in Taiwanese patients with AMI undergoing successful PCI.
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Yeh et al. (2021) conducted a cohort in Acute myocardial infarction (AMI) (n=10,100). De-escalation of P2Y12 inhibitor (switched to aspirin and clopidogrel) vs. Unchanged DAPT (continued on aspirin and ticagrelor) was evaluated on Major adverse cardiovascular events (MACE). De-escalation of P2Y12 inhibitor therapy to aspirin and clopidogrel was not associated with a higher risk of MACE (4.91 vs 4.72 per 100 person-years) compared to unchanged DAPT in AMI patients.
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