AUTHOR=Shin Eun-Seok , Jun Eun Jung , Kim Bitna , Kim Chan Joon , Park Mahn-Won , Choo Eun-Ho , Hwang Byung-Hee , Lee Kwan Yong , Oh Gyu-Chul , Kim Min Chul , Yim Hyeon Woo , Ahn Youngkeun , Chang Kiyuk 

TITLE=Sex-based outcomes on unguided de-escalation from ticagrelor to clopidogrel in stabilized patients with acute myocardial infarction undergoing percutaneous coronary intervention: a post-hoc analysis of the TALOS-AMI

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=11

YEAR=2024

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2024.1358657

DOI=10.3389/fcvm.2024.1358657

ISSN=2297-055X

ABSTRACT=<sec><title>Background</title><p>The TALOS-AMI study highlighted the effectiveness of a de-escalation strategy shifting from ticagrelor to clopidogrel 1 month after percutaneous coronary intervention (PCI), resulting in significant reduction in clinical events, primarily attributed to a substantial decrease in bleeding events. Nevertheless, the impact of this strategy on outcomes based on sex remains unclear.</p></sec><sec><title>Methods</title><p>This was a <italic>post-hoc</italic> analysis of the TALOS-AMI study. At 1 month after PCI, patients who remained adherent to aspirin and ticagrelor without experiencing major adverse events were randomized into either the de-escalation group (clopidogrel plus aspirin) or the active control group (ticagrelor plus aspirin) for an additional 12 months. The primary endpoint encompassed a composite of cardiovascular death, myocardial infarction, stroke, and Bleeding Academic Research Consortium bleeding type 2 or greater at 12 months after randomization.</p></sec><sec><title>Results</title><p>Among the 2,697 patients included in this study, 454 (16.8%) were women. Women, characterized by older age and a higher prevalence of hypertension, diabetes, impaired renal function, and non-ST-segment myocardial infarction, exhibited a lower primary endpoint at 12 months compared to men [adjusted hazards ratio (HR), 0.60; 95% confidence interval (CI), 0.37–0.95; <italic>P</italic> = 0.03]. Compare to the active control group, the de-escalation group demonstrated a reduced risk of the primary endpoint in both women (adjusted HR, 0.38; 95% CI, 0.15–0.95; <italic>P</italic> = 0.039) and men (adjusted HR, 0.56; 95% CI, 0.40–0.79; <italic>P</italic> = 0.001) (interaction <italic>P</italic> = 0.46).</p></sec><sec><title>Conclusions</title><p>In stabilized patients post-PCI with drug-eluting stents for acute myocardial infarction, the primary endpoint was lower among women compared to men. In this cohort, the benefits of an unguided de-escalation strategy from ticagrelor to clopidogrel were comparable in women and men.</p></sec>