Highlights from

ACC 2021

American College of Cardiology Annual Congress 2021

Virtual 15-17 May 2021

TALOS-AMI: Superior outcomes clopidogrel over ticagrelor following 1-month DAPT

Summary: In a study of 2,697 patients who had experienced an index myocardial infarction (MI) followed by percutaneous coronary intervention (PCI) and had completed 1 month of dual antiplatelet therapy (DAPT) with aspirin and ticagrelor, switching the P2Y12 inhibitor ticagrelor to clopidogrel achieved clinical benefits that were superior to remaining on ticagrelor.1 Participants who switched to clopidogrel experienced fewer events of cardiovascular death, MI, stroke, and bleeding than those who continued ticagrelor.

The risk of thrombosis is highest in the first 30 days following acute MI; thereafter, the risk of bleeding increases. Currently, patients who have experienced acute MI followed by PCI receive DAPT with aspirin and a P2Y12 inhibitor. It was unknown whether de-escalation of the P2Y12 inhibitor following the 30-day post-PCI can be done without increasing thrombosis risk. The TALOS-AMI trial (NCT02018055) aimed to address this question. The trial, presented by Prof Kiyuk Chang (Seoul St Mary’s Hospital, South Korea), compared outcomes of 1,349 participants who, after 1 month of taking aspirin plus ticagrelor following acute MI and PCI, switched to clopidogrel, with outcomes in 1,348 participants who remained on ticagrelor. Participants were monitored for 11 months (ie 1 year following MI and PCI.) The primary outcome was a composite of cardiovascular death, MI, stroke and academic research consortium (BARC) bleeding type 2, 3, or 5 between 1 month and 12 months post-PCI. At 1 year, 59 (4.6%) primary outcome events had occurred in the clopidogrel group as compared with 104 (8.2%) events in the ticagrelor group, yielding a hazard ratio of 0.55 (95% CI 0.40–0.76; P<0.001 for either non-inferiority or superiority). Researchers acknowledged that this trial is not without limitations; it was open-label and not placebo-controlled. Additionally, the study enrolled East Asian participants, so the generalisability of the results remains unclear.

  1. Chang K. A prospective, multi-centre, randomized, open-label trial to compare efficacy and safety of clopidogrel versus ticagrelor in stabilized patients with acute myocardial infarction after percutaneous coronary intervention. Abstract 407-10, ACC 2021 Scientific Session, 15-17 May 2021

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