Ticagrelor monotherapy following short-term DAPT in ACS undergoing PCI: A systematic review and meta-analysis

Authors

Rocio Barriga Guzman, Advocate Health - MidwestFollow
Manuel Villegas Roberson, Advocate Health - MidwestFollow
Larissa Teixeira, Federal University of Campina Grande, Campina Grande, Brazil.
Denilsa D. Navalha, University of Nebraska Medical Center, Omaha, USA.
Armando Talavera, Mount Sinai Medical Center, Miami Beach, USA.
Muhammad Ahmad, Advocate Health - Midwest
Yiannis Chatzizisis, University of Miami, Division of Cardiovascular Medicine, Miami, Florida, USA.
Nikolaos Spilias, University of Miami, Division of Cardiovascular Medicine, Miami, Florida, USA.

Recommended Citation

Guzman RB, Roberson MV, Teixeira L, et al. Ticagrelor Monotherapy Following Short-Term DAPT in ACS Undergoing PCI: A Systematic Review and Meta-Analysis. Catheter Cardiovasc Interv. Published online February 26, 2025. doi:10.1002/ccd.31459

Affiliations

Advocate Illinois Masonic Medical Center

Abstract

Background:Dual antiplatelet therapy (DAPT) for 1 year after acute coronary syndrome (ACS) in patients undergoing percutaneous coronary intervention (PCI) with drug-eluting stents (DES) is the standard of care. However, it is associated with a higher incidence of bleeding events. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to assess the safety and efficacy of short-term DAPT.

Aims:This study aimed to assess the relative risk of major and minor bleeding, net adverse clinical and cerebral events (NACCE), and all-cause mortality in patients with ACS undergoing PCI with DES, comparing ticagrelor-based short-term DAPT (≤ 3 months) followed by ticagrelor monotherapy for up to 12 months versus 12-month DAPT. The secondary endpoint evaluated the relative risk of complications, including myocardial infarction, stroke, stent thrombosis, repeat revascularization, and cardiovascular mortality.

Methods:A systematic search of PubMed, Scopus, and Cochrane Central was conducted for eligible RCTs. A subgroup analysis of ultrashort-term DAPT (≤ 1 month) followed by ticagrelor monotherapy for up to 12 months was also performed. Risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using a random-effects model.

Results:Five RCTs were included with a total of 21,407 patients. Short-term DAPT was associated with a significant reduction in major bleeding (RR 0.50; 95% CI 0.38-0.66; p < 0.01), minor bleeding (RR 0.53; 95% CI 0.35-0.80; p < 0.01), NACCE (RR 0.71; 95% CI 0.59-0.85; p < 0.01), and all-cause mortality (RR 0.78; 95% CI 0.62-0.98; p =0.04).

Conclusions:Short-term DAPT followed by ticagrelor monotherapy up to 12 months was associated with a significant reduction in major and minor bleeding, NACCE, and all-cause mortality compared to 12-month DAPT. There were no significant differences in myocardial infarction, stroke, stent thrombosis, repeat revascularization, or cardiovascular mortality. Major bleeding and NACCE remained consistently reduced in the subgroup analysis.

Document Type

Article

PubMed ID

40008572