AUTHOR=Kim Byung Gyu , Hong Sung-Jin , Kim Byeong-Keuk , Lee Yong-Joon , Lee Seung-Jun , Ahn Chul-Min , Shin Dong-Ho , Kim Jung-Sun , Ko Young-Guk , Choi Donghoon , Hong Myeong-Ki , Jang Yangsoo 

TITLE=Body mass index affecting ticagrelor monotherapy vs. ticagrelor with aspirin in patients with acute coronary syndrome: A pre-specified sub-analysis of the TICO randomized trial

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=10

YEAR=2023

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2023.1128834

DOI=10.3389/fcvm.2023.1128834

ISSN=2297-055X

ABSTRACT=<sec><title>Background</title><p>Although ticagrelor monotherapy after 3-month dual antiplatelet therapy (DAPT) results in a significantly greater net clinical benefit over that with ticagrelor-based 12-month DAPT in patients with acute coronary syndrome (ACS), it remains uncertain whether this effect is dependent on body mass index (BMI). We aimed to evaluate the BMI-dependent effect of these treatment strategies on clinical outcomes.</p></sec><sec><title>Methods</title><p>This was a pre-specified subgroup analysis from the TICO trial (Ticagrelor Monotherapy After 3 Months in Patients Treated With New Generation Sirolimus-eluting Stent for Acute Coronary Syndrome), evaluating the interaction between BMI and treatment strategies for the primary outcome [composite of major bleeding and adverse cardiac and cerebrovascular events (MACCE): death, myocardial infarction, stent thrombosis, stroke, or target-vessel revascularization]. The secondary outcomes were major bleeding and MACCE.</p></sec><sec><title>Results</title><p>Based on a pre-specified BMI threshold of 25 kg/m<sup>2</sup>, 3,056 patients were stratified. Patients with BMI &lt;25 kg/m<sup>2</sup> had a higher risk of primary and secondary outcomes than those with BMI ≥25 kg/m<sup>2</sup>. Regardless of the BMI subgroup, the effects of ticagrelor monotherapy after 3-month DAPT on the primary outcome (<italic>p</italic><sub>int </sub>= 0.61), major bleeding (<italic>p</italic><sub>int </sub>= 0.76), and MACCE (<italic>p</italic><sub>int </sub>= 0.80) were consistent without significant interaction compared with ticagrelor-based 12-month DAPT. The treatment effects according to the BMI quartiles and age, sex, and diabetic status were also consistent without significant interaction.</p></sec><sec><title>Conclusion</title><p>The BMI-dependent impact of ticagrelor monotherapy after 3-month DAPT compared with 12-month DAPT on clinical outcomes was not heterogeneous in patients with ACS.</p></sec><sec><title>Clinical Trial Registration</title><p>[<ext-link ext-link-type="uri" xlink:href="www.ClinicalTrials.gov" xmlns:xlink="http://www.w3.org/1999/xlink">www.ClinicalTrials.gov</ext-link>], identifier [NCT02494895].</p></sec>