# TALOS-AMI: DAPT de-escalatie veilig bij MI met hoog ischemisch risico

*geplaatst 2024-02-01 · Algemeen · JAMA cardiology · doi 10.1001/jamacardio.2023.4587 · https://hartvaat.nl/2024/02/01/talos-ami-dapt-de-escalatie-veilig-bij-mi-met-hoog-ischemisch-risico/*

Post-hoc analyse van TALOS-AMI bevestigde dat de-escalatie van DAPT (ticagrelor naar clopidogrel na 1 maand) ook veilig is bij patiënten met hoog ischemisch risico na MI. De strategie vermindert bloedingen zonder toename van ischemische events.

## English: Dual Antiplatelet Therapy De-Escalation in Stabilized Myocardial Infarction With High Ischemic Risk: Post Hoc Analysis of the TALOS-AMI Randomized Clinical Trial.

This TALOS-AMI post-hoc analysis confirmed that de-escalation from ticagrelor to clopidogrel after 1 month is safe even in high-ischemic-risk MI patients, extending the de-escalation evidence to the population with the greatest concern about reducing antiplatelet potency.

## Abstract (original, from the publication)

IMPORTANCE: In patients with acute myocardial infarction (AMI) who have high ischemic risk, data on the efficacy and safety of the de-escalation strategy of switching from ticagrelor to clopidogrel are lacking. OBJECTIVE: To evaluate the outcomes of the de-escalation strategy compared with dual antiplatelet therapy (DAPT) with ticagrelor in stabilized patients with AMI and high ischemic risk following percutaneous coronary intervention (PCI). DESIGN, SETTING, AND PARTICIPANTS: This was a post hoc analysis of the Ticagrelor vs Clopidogrel in Stabilized Patients With Acute Myocardial Infarction (TALOS-AMI) trial, an open-label, assessor-blinded, multicenter, randomized clinical trial. Patients with AMI who had no event during 1 month of ticagrelor-based DAPT after PCI were included. High ischemic risk was defined as having a history of diabetes or chronic kidney disease, multivessel PCI, at least 3 lesions treated, total stent length greater than 60 mm, at least 3 stents implanted, left main PCI, or bifurcation PCI with at least 2 stents. Data were collected from February 14, 2014, to January 21, 2021, and analyzed from December 1, 2021, to June 30, 2022. INTERVENTION: Patients were randomly assigned to either de-escalation from ticagrelor to clopidogrel or ticagrelor-based DAPT. MAIN OUTCOMES AND MEASURES: Ischemic outcomes (composite of cardiovascular death, myocardial infarction, ischemic stroke, ischemia-driven revascularization, or stent thrombosis) and bleeding outcomes (Bleeding Academic Research Consortium type 2, 3, or 5 bleeding) were evaluated. RESULTS: Of 2697 patients with AMI (mean [SD] age, 60.0 [11.4] years; 454 [16.8%] female), 1371 (50.8%; 684 assigned to de-escalation and 687 assigned to ticagrelor-based DAPT) had high ischemic risk features and a significantly higher risk of ischemic outcomes than those without high ischemic risk (1326 patients [49.2%], including 665 assigned to de-escalation and 661 assigned to ticagrelor-based DAPT) (hazard ratio [HR], 1.74; 95% CI, 1.15-2.63; P = .01). De-escalation to clopidogrel, compared with ticagrelor-based DAPT, showed no significant difference in ischemic risk across the high ischemic risk group (HR, 0.88; 95% CI, 0.54-1.45; P = .62) and the non-high ischemic risk group (HR, 0.65; 95% CI, 0.33-1.28; P = .21), without heterogeneity (P for interaction = .47). The bleeding risk of the de-escalation group was consistent in both the high ischemic risk group (HR, 0.64; 95% CI, 0.37-1.11; P = .11) and the non-high ischemic risk group (HR, 0.42; 95% CI, 0.24-0.75; P = .003), without heterogeneity (P for interaction = .32). CONCLUSIONS AND RELEVANCE: In stabilized patients with AMI, the ischemic and bleeding outcomes of an unguided de-escalation strategy with clopidogrel compared with a ticagrelor-based DAPT strategy were consistent without significant interaction, regardless of the presence of high ischemic risk.

Auteurs: Myunhee Lee, Sungwook Byun, Sungmin Lim, Eun Ho Choo, Kwan Yong Lee, Donggyu Moon, Ik Jun Choi, Byung-Hee Hwang, Chan Joon Kim, Mahn-Won Park, Yun Seok Choi, Hee-Yeol Kim, Ki-Dong Yoo, Doo-Soo Jeon, Hyeon Woo Yim, Kiyuk Chang

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Bron: JAMA cardiology, https://doi.org/10.1001/jamacardio.2023.4587. Bijgewerkt 2026-07-03T13:29:49Z. Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.