{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T14:55:42Z","timestamp":1783436142620,"version":"3.54.6"},"reference-count":45,"publisher":"American Medical Association (AMA)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>Chronic kidney disease (CKD) is a significant risk factor for both ischemic and bleeding complications following percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI). Optimizing dual antiplatelet therapy (DAPT) is essential for improving clinical outcomes.<\/jats:p><\/jats:sec>Objective<\/jats:title>To evaluate whether an 11-month, unguided deescalation strategy from ticagrelor to clopidogrel was associated with reduced bleeding without an increase in ischemic events in stabilized patients with CKD after AMI.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This was a post hoc secondary analysis of the multicenter, open-label, Ticagrelor vs Clopidogrel in Stabilized Patients With Acute Myocardial Infarction (TALOS-AMI) randomized clinical trial conducted at 32 major cardiac centers in South Korea. Patients with biomarker-positive AMI who tolerated 1 month of ticagrelor-based DAPT after PCI were included in the trial. Patient enrollment occurred from February 2014 to December 2018, with follow-up at 30 days and 3, 6, and 12 months after PCI. The present analysis focused on the subgroup of patients with CKD (estimated glomerular filtration rate [eGFR]&amp;lt;60 mL\/min\/1.73 m2<\/jats:sup>). Data analyses were performed from July 2023 to October 2024.<\/jats:p><\/jats:sec>Interventions<\/jats:title>In the TALOS-AMI trial, patients were randomized 1:1 to continue ticagrelor (active control group) or switch to clopidogrel (deescalation group) for 11 months after PCI.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>The primary end point was a composite of death from cardiovascular disease, myocardial infarction, stroke, and bleeding (Bleeding Academic Research Consortium [BARC] types 2, 3, or 5).<\/jats:p><\/jats:sec>Results<\/jats:title>Of 2646 patients included in the trial, 305 had CKD (11.5%; mean [SD] age, 67.2 [11.4] years; 223 males [73.1%]; mean [SD] eGFR, 49.7 [9.5] mL\/min\/1.73 m2<\/jats:sup>) and 2341 did not have CKD (1975 male [84.4%]; mean [SD] age, 59.0 [11.0] years). Patients with CKD had an increased risk of ischemic events compared with patients without CKD (hazard ratio [HR], 2.47; 95% CI, 1.38-4.42; P<\/jats:italic>\u2009=\u2009.002), but there was no difference in bleeding risk (HR, 1.36; 95% CI, 0.80-2.31; P<\/jats:italic>\u2009=\u2009.26). Among patients with CKD, deescalation (n\u2009=\u2009160) vs active control (n\u2009=\u2009145) was associated with reduced risks of the primary end point (10 patients [6.2%] vs 19 [13.1%]; HR, 0.45 [95% CI, 0.21-0.98]; P<\/jats:italic>\u2009=\u2009.04) and BARC 2, 3, or 5 bleeding (4 patients [2.5%] vs 12 [8.3%]; HR, 0.29 [95% CI, 0.09-0.89]; P<\/jats:italic>\u2009=\u2009.03). No increased risk of ischemic events was observed following deescalation (7 patients [4.4%] vs 8 [5.5%]; HR, 0.78 [95% CI, 0.28-2.16]; P<\/jats:italic>\u2009=\u2009.64).<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>In this secondary analysis of a randomized clinical trial, deescalation from ticagrelor to clopidogrel at 1 month after PCI for AMI was associated with significant reduction in bleeding without increased risk of ischemic events among study-eligible patients with CKD. Further adequately powered studies are needed to validate these findings.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2025.11297","type":"journal-article","created":{"date-parts":[[2025,5,20]],"date-time":"2025-05-20T15:00:43Z","timestamp":1747753243000},"page":"e2511297","source":"Crossref","is-referenced-by-count":2,"title":["Deescalation From Ticagrelor to Clopidogrel for Myocardial Infarction With Chronic Kidney Disease"],"prefix":"10.1001","volume":"8","author":[{"given":"Sang Hyun","family":"Kim","sequence":"first","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Seoul St Mary\u2019s Hospital, The Catholic University of Korea, Seoul, Republic of Korea"},{"name":"Division of Cardiology, Department of Internal Medicine, The Armed Forces Capital Hospital, Seongnam, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kwan Yong","family":"Lee","sequence":"additional","affiliation":[{"name":"Division of 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Soo","family":"Park","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Yeouido St Mary\u2019s Hospital, The Catholic University of Korea, Seoul, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahn-Won","family":"Park","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Daejeon St Mary\u2019s Hospital, The Catholic University of Korea, Daejeon, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sung-Ho","family":"Her","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, St Vincent\u2019s Hospital, The Catholic University of Korea, Suwon, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Myunhee","family":"Lee","sequence":"additional","affiliation":[{"name":"School of Public Health, San Diego State University, San Diego, 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