TY - JOUR
T1 - Abbreviated ticagrelor based dual antiplatelet therapy in acute coronary syndrome
T2 - A systematic review and meta-analysis
AU - Harmouch, Wissam
AU - Thakker, Ravi
AU - Khalid, Mirza Umair
AU - Khalife, Wissam
AU - Kleiman, Neal
AU - Rangasetty, Umamahesh
AU - Kayani, Waleed Tallat
AU - Jneid, Hani
AU - Al-Hemyari, Bashar
AU - Elbadawi, Ayman
N1 - Publisher Copyright:
© 2024 Elsevier Inc.
PY - 2024
Y1 - 2024
N2 - Background: Few randomized clinical trials have evaluated the safety and efficacy of abbreviated ticagrelor based dual antiplatelet therapy (DAPT) in acute coronary syndrome (ACS); however, these trials were underpowered to detect differences in hard clinical outcomes. Methods: A systematic search of MEDLINE, Cochrane, and Scopus databases was performed through June 2024, for trials that compared abbreviated (≤3-months) versus standard 12-months ticagrelor based DAPT in ACS. The primary endpoint was all-cause mortality. Secondary endpoints included cardiovascular death, myocardial infarction, stent thrombosis, ischemic stroke, and major bleeding. Endpoints were measured at 12-months after DAPT initiation. Data were pooled using random-effects model. Effect measure utilized was risk ratio (RR). Heterogeneity was assessed via Chi-squared and Higgin's I2 test. RevMan 5.0 (Cochrane Collaboration, Oxford, United Kingdom) was utilized to perform statistical analysis. Results: Five trials were included in this analysis with 21,407 patients assessed. ULTIMATE-DAPT, T-PASS, and GLOBAL LEADERS-ACS assessed 1-month DAPT duration while TICO and TWILIGHT-ACS assessed 3-months DAPT duration. The average age was 62.7 years and 22.7 % were women. ACS presentations included non-ST elevation myocardial infarction (40.1 %), unstable angina (35.2 %), and ST-segment elevation myocardial infarction (31.5 %). Abbreviated ticagrelor based DAPT was associated with lower risk of all-cause mortality (RR 0.78; 95 % Confidence Interval (CI) 0.62–0.98, I2 = 0 %) compared with standard duration DAPT. There was no difference between groups in cardiovascular death (RR 0.65; 95 % CI 0.41–1.03, I2 = 0 %), myocardial infarction (RR 1.04; 95 % CI 0.85–1.27, I2 = 0 %), stent thrombosis (RR 0.97; 95 % CI 0.64–1.45, I2 = 0 %), or ischemic stroke (RR 0.90; 95 % CI 0.62–1.30, I2 = 0 %). Abbreviated DAPT was associated with lower risk of major bleeding (RR 0.50; 95 % CI 0.38–0.66, I2 = 46 %). Conclusion: Our analysis includes the totality of randomized data evaluating the merits of abbreviated ticagrelor based DAPT after ACS. The salient study finding was the observed reduced risk of all-cause mortality and major bleeding with abbreviated DAPT approach.
AB - Background: Few randomized clinical trials have evaluated the safety and efficacy of abbreviated ticagrelor based dual antiplatelet therapy (DAPT) in acute coronary syndrome (ACS); however, these trials were underpowered to detect differences in hard clinical outcomes. Methods: A systematic search of MEDLINE, Cochrane, and Scopus databases was performed through June 2024, for trials that compared abbreviated (≤3-months) versus standard 12-months ticagrelor based DAPT in ACS. The primary endpoint was all-cause mortality. Secondary endpoints included cardiovascular death, myocardial infarction, stent thrombosis, ischemic stroke, and major bleeding. Endpoints were measured at 12-months after DAPT initiation. Data were pooled using random-effects model. Effect measure utilized was risk ratio (RR). Heterogeneity was assessed via Chi-squared and Higgin's I2 test. RevMan 5.0 (Cochrane Collaboration, Oxford, United Kingdom) was utilized to perform statistical analysis. Results: Five trials were included in this analysis with 21,407 patients assessed. ULTIMATE-DAPT, T-PASS, and GLOBAL LEADERS-ACS assessed 1-month DAPT duration while TICO and TWILIGHT-ACS assessed 3-months DAPT duration. The average age was 62.7 years and 22.7 % were women. ACS presentations included non-ST elevation myocardial infarction (40.1 %), unstable angina (35.2 %), and ST-segment elevation myocardial infarction (31.5 %). Abbreviated ticagrelor based DAPT was associated with lower risk of all-cause mortality (RR 0.78; 95 % Confidence Interval (CI) 0.62–0.98, I2 = 0 %) compared with standard duration DAPT. There was no difference between groups in cardiovascular death (RR 0.65; 95 % CI 0.41–1.03, I2 = 0 %), myocardial infarction (RR 1.04; 95 % CI 0.85–1.27, I2 = 0 %), stent thrombosis (RR 0.97; 95 % CI 0.64–1.45, I2 = 0 %), or ischemic stroke (RR 0.90; 95 % CI 0.62–1.30, I2 = 0 %). Abbreviated DAPT was associated with lower risk of major bleeding (RR 0.50; 95 % CI 0.38–0.66, I2 = 46 %). Conclusion: Our analysis includes the totality of randomized data evaluating the merits of abbreviated ticagrelor based DAPT after ACS. The salient study finding was the observed reduced risk of all-cause mortality and major bleeding with abbreviated DAPT approach.
KW - Acute coronary syndrome
KW - Bleeding
KW - Dual antiplatelet therapy
KW - Percutaneous coronary intervention
KW - Ticagrelor monotherapy
UR - http://www.scopus.com/inward/record.url?scp=85204887011&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85204887011&partnerID=8YFLogxK
U2 - 10.1016/j.carrev.2024.09.005
DO - 10.1016/j.carrev.2024.09.005
M3 - Article
AN - SCOPUS:85204887011
SN - 1553-8389
JO - Cardiovascular Revascularization Medicine
JF - Cardiovascular Revascularization Medicine
ER -