Ticagrelor Monotherapy vs. Ticagrelor With Aspirin in Bleeding and Cardiovascular Events in Acute Coronary Syndrome Patients According to Renal Function: The Subanalysis From the TICO Trial

Abstract

Background and Objectives: Ticagrelor monotherapy after short-term dual-antiplatelet therapy (DAPT) has not been established in chronic kidney disease (CKD) patients. This study evaluated the effects of ticagrelor monotherapy after 3-month of DAPT on renal function in acute coronary syndrome patients. Methods: From the TICO trial, the primary outcome was a composite of net adverse clinical events (NACEs), defined as a composite of major bleeding and major adverse cardiovascular and cerebrovascular events (MACCEs). The secondary outcomes were thrombolysis in myocardial infarction (TIMI) major or minor bleeding and MACCE. Results: Among patients without CKD (n=2,436), ticagrelor monotherapy after 3 months of DAPT had a lower rate of NACE (hazard ratio [HR], 0.41; 95% confidence interval [CI], 0.21-0.78; p=0.007) and TIMI bleeding (HR, 0.86; 95% CI, 0.19-0.81; p=0.011) than those of ticagrelor-based 12-month DAPT. Among CKD patients receiving ticagrelor monotherapy, lower risk of NACE (HR, 0.45; 95% CI, 0.20-1.02; p=0.055) and bleeding (HR, 0.20; 95% CI, 0.06-0.68; p=0.009) were observed. Otherwise, ticagrelor monotherapy was not significantly associated with an increased MACCE risk in those without CKD (HR, 0.62; 95% CI, 0.30-1.27; p=0.192) or with CKD (HR, 0.55; 95% CI, 0.21-1.48; p=0.237), versus 12-month DAPT. Conclusions: Regardless of renal function, ticagrelor monotherapy after 3 months of DAPT resulted in a reduced risk of not only NACE but also major or minor bleeding at 1 year compared with ticagrelor-based 12-month DAPT. Irrespective of renal function status, however, the MACCE risk was not significantly different between the two strategies.