{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T13:23:30Z","timestamp":1785763410670,"version":"3.56.0"},"reference-count":36,"publisher":"American Medical Association (AMA)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Cardiol"],"published-print":{"date-parts":[[2024,2,1]]},"abstract":"Importance<\/jats:title>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.<\/jats:p><\/jats:sec>Objective<\/jats:title>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).<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>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.<\/jats:p><\/jats:sec>Intervention<\/jats:title>Patients were randomly assigned to either de-escalation from ticagrelor to clopidogrel or ticagrelor-based DAPT.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>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.<\/jats:p><\/jats:sec>Results<\/jats:title>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<\/jats:italic>\u2009=\u2009.01). 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<\/jats:italic>\u2009=\u2009.62) and the non\u2013high ischemic risk group (HR, 0.65; 95% CI, 0.33-1.28; P<\/jats:italic>\u2009=\u2009.21), without heterogeneity (P<\/jats:italic> for interaction\u2009=\u2009.47). 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<\/jats:italic>\u2009=\u2009.11) and the non\u2013high ischemic risk group (HR, 0.42; 95% CI, 0.24-0.75; P<\/jats:italic>\u2009=\u2009.003), without heterogeneity (P<\/jats:italic> for interaction\u2009=\u2009.32).<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>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.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamacardio.2023.4587","type":"journal-article","created":{"date-parts":[[2023,12,20]],"date-time":"2023-12-20T16:01:50Z","timestamp":1703088110000},"page":"125","source":"Crossref","is-referenced-by-count":11,"title":["Dual Antiplatelet Therapy De-Escalation in Stabilized Myocardial 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