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Stopping Aspirin Within 1 Month After Stenting for Ticagrelor Monotherapy in Acute Coronary Syndrome: The T-PASS Randomized Noninferiority Trial
DC Field | Value | Language |
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dc.contributor.author | 고영국 | - |
dc.contributor.author | 김병극 | - |
dc.contributor.author | 김중선 | - |
dc.contributor.author | 안철민 | - |
dc.contributor.author | 이승준 | - |
dc.contributor.author | 이용준 | - |
dc.contributor.author | 조덕규 | - |
dc.contributor.author | 최동훈 | - |
dc.contributor.author | 홍명기 | - |
dc.contributor.author | 홍성진 | - |
dc.date.accessioned | 2024-04-11T06:27:51Z | - |
dc.date.available | 2024-04-11T06:27:51Z | - |
dc.date.issued | 2024-02 | - |
dc.identifier.issn | 0009-7322 | - |
dc.identifier.uri | https://ir.ymlib.yonsei.ac.kr/handle/22282913/198798 | - |
dc.description.abstract | Background: Stopping aspirin within 1 month after implantation of a drug-eluting stent (DES) for ticagrelor monotherapy has not been exclusively evaluated for patients with acute coronary syndrome (ACS). The aim of this study was to investigate whether ticagrelor monotherapy after <1 month of dual antiplatelet therapy (DAPT) is noninferior to 12 months of ticagrelor-based DAPT for adverse cardiovascular and bleeding events in patients with ACS. Methods: In this randomized, open-label, non-inferiority trial, 2850 patients with ACS who underwent DES implantation at 24 centres in South Korea were randomly assigned (1:1) to receive either ticagrelor monotherapy (90 mg twice daily) after <1 month of DAPT (n=1426) or 12 months of ticagrelor-based DAPT (n=1424) between Apr 24, 2019, and May 31, 2022. The primary endpoint was the net clinical benefit as a composite of all-cause death, myocardial infarction, definite or probable stent thrombosis, stroke, and major bleeding at 1 year after the index procedure in the intention-to-treat population. Key secondary endpoints were the individual components of the primary endpoint. Results: Among 2850 patients who were randomized (mean age, 61 years; 40% ST-elevation myocardial infarction), 2823 (99.0%) completed the trial. Aspirin was discontinued at a median of 16 days (interquartile range, 12 to 25 days) in the group receiving ticagrelor monotherapy after <1 month of DAPT. The primary endpoint occurred in 40 patients (2.8%) in the group receiving ticagrelor monotherapy after <1-month DAPT, and in 73 patients (5.2%) in the ticagrelor-based 12-month DAPT group (hazard ratio [HR], 0.54 [95% CI, 0.37-0.80]; P<0.001 for noninferiority; P=0.002 for superiority). This finding was consistent in the per-protocol population as a sensitivity analysis. The occurrence of major bleeding was significantly lower in the ticagrelor monotherapy after <1-month DAPT group compared with the 12-month DAPT group (1.2% versus 3.4%; HR, 0.35 [95% CI, 0.20-0.61]; P<0.001). Conclusions: This study provides evidence that stopping aspirin within 1 month for ticagrelor monotherapy is both noninferior and superior to 12-month DAPT as for the 1-year composite outcome of death, myocardial infarction, stent thrombosis, stroke, and major bleeding, primarily due to a significant reduction in major bleeding, among ACS patients receiving DES implantation. Low event rates which may suggest enrolment of relatively non-high-risk patients should be considered in interpreting the trial. | - |
dc.description.statementOfResponsibility | restriction | - |
dc.language | English | - |
dc.publisher | Lippincott Williams & Wilkins | - |
dc.relation.isPartOf | CIRCULATION | - |
dc.rights | CC BY-NC-ND 2.0 KR | - |
dc.subject.MESH | Acute Coronary Syndrome* / drug therapy | - |
dc.subject.MESH | Acute Coronary Syndrome* / surgery | - |
dc.subject.MESH | Aspirin / therapeutic use | - |
dc.subject.MESH | Drug Therapy, Combination | - |
dc.subject.MESH | Drug-Eluting Stents* / adverse effects | - |
dc.subject.MESH | Hemorrhage / etiology | - |
dc.subject.MESH | Humans | - |
dc.subject.MESH | Middle Aged | - |
dc.subject.MESH | Myocardial Infarction* / drug therapy | - |
dc.subject.MESH | Percutaneous Coronary Intervention* / adverse effects | - |
dc.subject.MESH | Percutaneous Coronary Intervention* / methods | - |
dc.subject.MESH | Platelet Aggregation Inhibitors / therapeutic use | - |
dc.subject.MESH | Stroke* / etiology | - |
dc.subject.MESH | Thrombosis* / etiology | - |
dc.subject.MESH | Ticagrelor / adverse effects | - |
dc.subject.MESH | Treatment Outcome | - |
dc.title | Stopping Aspirin Within 1 Month After Stenting for Ticagrelor Monotherapy in Acute Coronary Syndrome: The T-PASS Randomized Noninferiority Trial | - |
dc.type | Article | - |
dc.contributor.college | College of Medicine (의과대학) | - |
dc.contributor.department | Dept. of Internal Medicine (내과학교실) | - |
dc.contributor.googleauthor | Sung-Jin Hong | - |
dc.contributor.googleauthor | Seung-Jun Lee | - |
dc.contributor.googleauthor | Yongsung Suh | - |
dc.contributor.googleauthor | Kyeong Ho Yun | - |
dc.contributor.googleauthor | Tae Soo Kang | - |
dc.contributor.googleauthor | Sanghoon Shin | - |
dc.contributor.googleauthor | Sung Woo Kwon | - |
dc.contributor.googleauthor | Jun-Won Lee | - |
dc.contributor.googleauthor | Deok-Kyu Cho | - |
dc.contributor.googleauthor | Jong-Kwan Park | - |
dc.contributor.googleauthor | Jang-Whan Bae | - |
dc.contributor.googleauthor | Woong Cheol Kang | - |
dc.contributor.googleauthor | Seunghwan Kim | - |
dc.contributor.googleauthor | Yong-Joon Lee | - |
dc.contributor.googleauthor | Chul-Min Ahn | - |
dc.contributor.googleauthor | Jung-Sun Kim | - |
dc.contributor.googleauthor | Byeong-Keuk Kim | - |
dc.contributor.googleauthor | Young-Guk Ko | - |
dc.contributor.googleauthor | Donghoon Choi | - |
dc.contributor.googleauthor | Yangsoo Jang | - |
dc.contributor.googleauthor | Myeong-Ki Hong | - |
dc.contributor.googleauthor | T-PASS (Ticagrelor Monotherapy in Patients Treated With New-Generation Drug-Eluting Stents for Acute Coronary Syndrome) Investigators | - |
dc.identifier.doi | 10.1161/circulationaha.123.066943 | - |
dc.contributor.localId | A00127 | - |
dc.contributor.localId | A00493 | - |
dc.contributor.localId | A00961 | - |
dc.contributor.localId | A02269 | - |
dc.contributor.localId | A02927 | - |
dc.contributor.localId | A06392 | - |
dc.contributor.localId | A03813 | - |
dc.contributor.localId | A04053 | - |
dc.contributor.localId | A04391 | - |
dc.contributor.localId | A04403 | - |
dc.relation.journalcode | J00533 | - |
dc.identifier.eissn | 1524-4539 | - |
dc.identifier.pmid | 37878786 | - |
dc.identifier.url | https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.123.066943 | - |
dc.subject.keyword | acute coronary syndrome | - |
dc.subject.keyword | antiplatelet agent | - |
dc.subject.keyword | aspirin | - |
dc.subject.keyword | drug-eluting stents | - |
dc.contributor.alternativeName | Ko, Young Guk | - |
dc.contributor.affiliatedAuthor | 고영국 | - |
dc.contributor.affiliatedAuthor | 김병극 | - |
dc.contributor.affiliatedAuthor | 김중선 | - |
dc.contributor.affiliatedAuthor | 안철민 | - |
dc.contributor.affiliatedAuthor | 이승준 | - |
dc.contributor.affiliatedAuthor | 이용준 | - |
dc.contributor.affiliatedAuthor | 조덕규 | - |
dc.contributor.affiliatedAuthor | 최동훈 | - |
dc.contributor.affiliatedAuthor | 홍명기 | - |
dc.contributor.affiliatedAuthor | 홍성진 | - |
dc.citation.volume | 149 | - |
dc.citation.number | 8 | - |
dc.citation.startPage | 562 | - |
dc.citation.endPage | 573 | - |
dc.identifier.bibliographicCitation | CIRCULATION, Vol.149(8) : 562-573, 2024-02 | - |
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