STUDY DESIGN 

The 2023 ESC guidelines advocate for a standard treatment of 12-month dual antiplatelet therapy (DAPT) in patients with acute coronary syndrome (ACS) as a Class I recommendation with a high level of evidence.¹ For those who may benefit from shorter DAPT regimens depending on their specific high bleeding risk factors, a shorter course of less than 12 months may also be recommended.¹ Furthermore, the selection of single antiplatelet therapy following the cessation of DAPT has been recognized as an important factor that may influence outcomes when comparing abbreviated vs. standard DAPT regimens.¹ 

A systematic review and individual patient data (IPD) level meta-analysis of randomized trials with centrally adjudicated endpoints were conducted to assess the efficacy and safety of ticagrelor monotherapy at 90mg twice daily following short-term dual antiplatelet therapy (DAPT) compared to a full 12-month DAPT regimen in patients undergoing percutaneous coronary intervention (PCI).¹ Studies that were randomized before the common DAPT phase were censored.1 The final review included the GLASSY, SMART-CHOICE, TICO, TWILIGHT, T-PASS, ULTIMATE-DAPT studies.¹ 

The presentation reported three ranked co-primary endpoints.¹ The first was major adverse cardiovascular or cerebrovascular events (MACCE), a composite of all-cause death, myocardial infarction (MI), or stroke evaluated for non-inferiority.¹ The second and third co-primary endpoints were Bleeding Academic Research Consortium (BARC) type 3 or 5 bleeding and all-cause death, both of which were assessed for superiority in the intention-to-treat (ITT) population.¹ Additionally, trial sequential analysis was performed on the three co-primary endpoints.¹ 

FINDINGS 

Professor Marco Valgimigli 
Cardiocentro Ticino Institute 
Lugano, Switzerland 

We provide conclusive evidence that DAPT de-escalation to ticagrelor monotherapy preserves the fatal and non-fatal ischemia and halves major bleeding risks compared with 1-year DAPT