Sex-based Outcomes on Unguided De-escalation from Ticagrelor to Clopidogrel in Stabilized Patients with Acute Myocardial Infarction Undergoing Percutaneous Coronary Intervention: a Analysis of the TALOS-AMI

Overview

Journal Front Cardiovasc Med

Specialty Cardiology & Vascular Diseases

Date 2024 Apr 8

PMID 38586173

Authors

Eun-Seok Shin

Eun Jung Jun

Bitna Kim

Chan Joon Kim

Mahn-Won Park

Eun-Ho Choo

Byung-Hee Hwang

Kwan Yong Lee

Gyu-Chul Oh

Min Chul Kim

Hyeon Woo Yim

Youngkeun Ahn

Kiyuk Chang

Affiliations

Soon will be listed here.

Abstract

Background: The TALOS-AMI study highlighted the effectiveness of a de-escalation strategy shifting from ticagrelor to clopidogrel 1 month after percutaneous coronary intervention (PCI), resulting in significant reduction in clinical events, primarily attributed to a substantial decrease in bleeding events. Nevertheless, the impact of this strategy on outcomes based on sex remains unclear.

Methods: This was a analysis of the TALOS-AMI study. At 1 month after PCI, patients who remained adherent to aspirin and ticagrelor without experiencing major adverse events were randomized into either the de-escalation group (clopidogrel plus aspirin) or the active control group (ticagrelor plus aspirin) for an additional 12 months. The primary endpoint encompassed a composite of cardiovascular death, myocardial infarction, stroke, and Bleeding Academic Research Consortium bleeding type 2 or greater at 12 months after randomization.

Results: Among the 2,697 patients included in this study, 454 (16.8%) were women. Women, characterized by older age and a higher prevalence of hypertension, diabetes, impaired renal function, and non-ST-segment myocardial infarction, exhibited a lower primary endpoint at 12 months compared to men [adjusted hazards ratio (HR), 0.60; 95% confidence interval (CI), 0.37-0.95; = 0.03]. Compare to the active control group, the de-escalation group demonstrated a reduced risk of the primary endpoint in both women (adjusted HR, 0.38; 95% CI, 0.15-0.95; = 0.039) and men (adjusted HR, 0.56; 95% CI, 0.40-0.79; = 0.001) (interaction = 0.46).

Conclusions: In stabilized patients post-PCI with drug-eluting stents for acute myocardial infarction, the primary endpoint was lower among women compared to men. In this cohort, the benefits of an unguided de-escalation strategy from ticagrelor to clopidogrel were comparable in women and men.

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