Stopping Aspirin Within 1 Month After Stenting for Ticagrelor Monotherapy in Acute Coronary Syndrome: The T-PASS Randomized Noninferiority Trial

• DOI: 10.1161/circulationaha.123.066943
• Publication Date: 2023-10-25T18:44:09Z
• Authors: Sung-Jin Hong; Seung-Jun Lee; Yongsung Suh; Kyeong Ho Yun; Tae Soo Kang; Sanghoon Shin; Sung Woo Kwon; Jun-Won Lee; Deok-Kyu Cho; Jong-Kwan Park; Jang-Whan Bae; Woong Cheol Kang; Seunghwan Kim; Yong-Joon Lee; Chul-Min Ahn; Jung-Sun Kim; Byeong-Keuk Kim; Young-Guk Ko; Donghoon Choi; Yangsoo Jang; Myeong-Ki Hong
• Keywords: Coronary stenting

BACKGROUND: Stopping aspirin within 1 month after implantation of a drug-eluting stent for ticagrelor monotherapy has not been exclusively evaluated patients with acute coronary syndrome. The aim this study was to investigate whether <1 dual antiplatelet therapy (DAPT) is noninferior 12 months ticagrelor-based DAPT adverse cardiovascular and bleeding events in METHODS: In randomized, open-label, noninferiority trial, 2850 syndrome who underwent at 24 centers South Korea were randomly assigned (1:1) receive either (90 mg twice daily) (n=1426) or (n=1424) between April 24, 2019, May 31, 2022. primary end point the net clinical benefit as composite all-cause death, myocardial infarction, definite probable thrombosis, stroke, major year index procedure intention-to-treat population. Key secondary points individual components point. RESULTS: Among randomized (mean age, 61 years; 40% ST-segment–elevation infarction), 2823 (99.0%) completed trial. Aspirin discontinued median 16 days (interquartile range, 12–25 days) group receiving DAPT. occurred 40 (2.8%) <1-month DAPT, 73 (5.2%) 12-month (hazard ratio, 0.54 [95% CI, 0.37–0.80]; P <0.001 noninferiority; =0.002 superiority). This finding consistent per-protocol population sensitivity analysis. occurrence significantly lower compared (1.2% versus 3.4%; hazard 0.35 0.20–0.61]; <0.001). CONCLUSIONS: provides evidence that stopping both superior 1-year outcome bleeding, primarily because significant reduction among implantation. Low event rates, which may suggest enrollment relatively non–high-risk patients, should be considered interpreting REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03797651.