Lancet

ACC 2024: Dual antiplatelet therapy vs. monotherapy after PCI for ACS

April 9, 2024

In patients with acute coronary syndrome (ACS) who had percutaneous coronary intervention (PCI) with drug-eluting stents and remained event-free for 1 month on dual antiplatelet therapy (DAPT), use of ticagrelor alone between month 1 and month 12 resulted in a lower rate of clinically relevant bleeding and a similar rate of major adverse CV or cerebrovascular events (MACCE), vs. ticagrelor plus aspirin.

In the randomized, placebo-controlled, double-blind ULTIMATE-DAPT trial, adults ≥18 years of age with an ACS who completed the IVUS-ACS study and who had no major ischemic or bleeding events after 1-month treatment with DAPT were randomly assigned to receive oral ticagrelor (90 mg bid) plus oral aspirin (100 mg once daily) or oral ticagrelor (90 mg bid) plus matching oral placebo, beginning 1 month and ending at 12 months after PCI. Patients were required to remain event-free for 1 month on DAPT following PCI with contemporary drug-eluting stents.

Between 2019 and Oct 2022, 3400 (97.0%) of the 3,505 participants in the IVUS-ACS study were randomly assigned (1,700 patients to ticagrelor plus aspirin and 1,700 patients to ticagrelor plus placebo). Twelve-month follow-up was completed by 3,399 (>99.9%) patients. Between month 1 and month 12 after PCI, the rate of clinically relevant bleeding was 2.1% in the ticagrelor plus placebo group vs. 4.6% in the ticagrelor plus aspirin group (hazard ratio, 0.45; 95% confidence interval, 0.30-0.66; p<0.0001). Rate of MACCE was 3.6% in the ticagrelor plus placebo group vs. 3.7% in the ticagrelor plus aspirin group.

Given the findings, authors conclude that most patients in this population can benefit from aspirin discontinuation and maintenance of ticagrelor monotherapy after 1 month of DAPT.

Source:

Ge Z, et al. (2024, April 7). Lancet. Ticagrelor alone versus ticagrelor plus aspirin from month 1 to month 12 after percutaneous coronary intervention in patients with acute coronary syndromes (ULTIMATE-DAPT): a randomised, placebo-controlled, double-blind clinical trial. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)00473-2/abstract