AUTHOR=Cho Jae Young , Joo Donghyeon , Yun Kyeong Ho , Kim Byeong-Keuk , Hong Myeong-Ki , Jang Yangsoo , Oh Seok Kyu 

TITLE=Clinical implication of ticagrelor monotherapy in patients with small vessel coronary artery disease: results from 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.2023.1237826

DOI=10.3389/fcvm.2023.1237826

ISSN=2297-055X

ABSTRACT=<sec><title>Background</title><p>The aim of this study was to evaluate the efficacy and safety of ticagrelor monotherapy in patients with small vessel disease compared with ticagrelor-based DAPT within the Ticagrelor Monotherapy after 3 Months in the Patients Treated with New Generation Sirolimus Eluting Stent for Acute Coronary Syndrome (TICO) trial population.</p></sec><sec><title>Methods</title><p>Reference vessel diameter ≤2.5 mm was considered as small vessel disease. We conducted a comparison of the incidence of target lesion failure (TLF) and Bleeding Academic Research Consortium (BARC) type 3 or 5 bleeding. TLF was defined as a composite of cardiac death, target lesion myocardial infarction, stent thrombosis, and target lesion revascularization.</p></sec><sec><title>Results</title><p>652 patients among 3,056 TICO population (21.3%) had small vessel disease. Patients with small vessel disease showed a higher rate of TLF compared to those without small vessel disease (2.9% vs. 1.0%, log-rank <italic>p</italic> &lt; 0.001). The presence of small vessel disease emerged as an independent predictor for 1-year TLF (HR 2.84, 95% CI 1.54–5.25), while it did not show a significant association with bleeding complications. The 12-month TLF rate was 1.6% for ticagrelor monotherapy after 3-month DAPT, and 4.2% for ticagrelor-based 12-month DAPT (<italic>p</italic> = 0.059) in patients with small vessel disease (HR 0.38, 95% CI 0.14–1.04, <italic>p</italic> for interaction = 0.261). The incidence of BARC type 3 or 5 bleeding rate 2.5% for ticagrelor monotherapy after 3-month DAPT, and 5.6% for ticagrelor-based 12-month DAPT (<italic>p</italic> = 0.052) in patients with small vessel disease (HR 0.44, 95% CI 0.19–1.01, <italic>p</italic> for interaction = 0.322). In the 3-month landmark analysis, ticagrelor monotherapy significantly reduced BARC type 3 or 5 bleeding in patients with small vessel disease (HR 0.09, 95% CI 0.01–0.69, log-rank <italic>p</italic> = 0.005) while demonstrating a similar incidence of TLF compared to ticagrelor based 12-month DAPT during the 3–12 months period.</p></sec><sec><title>Conclusions</title><p>There are no significant interactions between the antiplatelet strategy regarding the 12-month incidence of ischemic and bleeding complications. Ticagrelor monotherapy demonstrated a reduction in bleeding complications after a 3-month period of DAPT without increasing the rate of TLF, when compared to ticagrelor-based 12-month DAPT, specifically in patients with small vessel disease.</p><p><bold>Clinical Trial Registration</bold>: <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>