Key result
Ticagrelor monotherapy fails noninferiority for MACCE versus aspirin plus prasugrel despite reducing major bleeding.
Why the study?
The 2025 ACC/AHA guidelines endorse de-escalation to ticagrelor monotherapy after PCI for ACS, whereas the 2023 ESC guidelines recommend 12-month DAPT with aspirin plus prasugrel, creating uncertainty about comparative outcomes.
Does de-escalation to ticagrelor monotherapy reduce ischemic and bleeding outcomes compared to 12-month DAPT with aspirin plus prasugrel in patients after PCI?
Meta-Analysis (n=27,225)
Does de-escalation to ticagrelor monotherapy reduce ischemic and bleeding outcomes compared to 12-month DAPT with aspirin plus prasugrel in patients after PCI?
In a network meta-analysis of post-PCI patients, ticagrelor monotherapy significantly reduced major bleeding compared to 12 months of aspirin plus prasugrel, though it failed to meet noninferiority for MACCE.
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Maremmani et al. (2026) conducted a meta-analysis in Acute coronary syndromes undergoing percutaneous coronary intervention (n=27,225). Ticagrelor monotherapy vs. 12-month DAPT with aspirin plus prasugrel was evaluated on Major adverse cardiovascular or cerebrovascular events (MACCE) (IRR 1.09, 95% CI 0.86-1.38, p=0.33 for noninferiority). Ticagrelor monotherapy did not meet noninferiority for MACCE compared with aspirin plus prasugrel (IRR 1.09; 95% CI 0.86-1.38; P=0.33 for noninferiority), though it reduced major bleeding.
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