ACC 2024 | ULTIMATE-DAPT Trial

The international guidelines recommend the use of dual antiplatelet therapy (DAPT) with aspirin plus a P2Y12 inhibitor during 12 months in patients receiving percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS), to prevent events such as MI and stent thrombosis. 

ACC 2024

This was a multicenter, placebo controlled, double blind study to determine whether ticagrelor alone, started 30 days after PCI, might reduce relevant bleeding without increasing major adverse cardiovascular events (MACCE) vs. ticagrelor + aspirin. 

It included patients with ACS 30 days prior randomization, with biomarkers for STEMI and NSTEMI or negative biomarkers (unusable angina) with >90% stenosis or plaque rupture or thrombotic lesion, treated with DES and one month DAPT (ticagrelor 90mg and aspirin 100mg). It excluded patients with stroke within 90 days prior procedure, prior CABG, chronic anticoagulation, GFR <20ml/min/1.73m2.

Efficacy primary outcome was clinically relevant bleeding (BARC 2, 3 or 5) and safety end point was the composite of MACCE (cardiac death, AMI, ischemic stroke, stent thrombosis or ischemia driven revascularization).

Read also: ACC 2024 | RELIEVE-HF.

The study included 3400 patients randomized 1:1, stratified according to ACS, presence of diabetes, use of intravascular imaging (IVUS) vs. angiography and lesion site, followed up to 1 year. Mean age was 62, 74.4% were men, and most were Asian (86.8% Chinese). As regards the clinical presentation, 39.3% presented unstable angina, 32.1% NSTEMI and 28.7% STEMI.

As regards the procedure, the transradial approach was used in 96.8% of cases, guided by IVUS in 50.2%. There was low use of aspiration devices (1.4%) and atherectomy (0.2%), and the most commonly used stents were Firehawk (51.4%), followed by Resolute (42.2%).

As regards outcomes, there was significant and substantial reduction of clinically relevant bleeding with ticagrelor monotherapy (HR 0.45, CI 95% 0.30-0.66; p<0.0001). In terms of safety, there were no significant differences in MACCE between the strategies and statistical significance was achieved for non-inferiority (HR 0.98, CI 95% 0.69-1.39; P for non-inferiority <0.0001).

Read also: Lithotripsy in the “Real World”: REPLICA EPIC-18 Study.

In conclusion, in patients with SCA treated with PCI with DES free from major adverse cardiovascular events after one month DAPT, ticagrelor monotherapy significantly reduced clinically relevant bleeding without compromising protection against MACCE vs. DAPT with ticagrelor and aspirin.

Dr. Omar Tupayachi

Dr. Omar Tupayachi.
Member of the Editorial Board of SOLACI.org.

Original Title: Monoterapia de un mes con ticagrelor post PCI en síndromes coronarios agudos.

Reference: Presentado por Dr. Gregg Stone en ACC.24 Late-Breaking Clinical Trials, 6-8 de abril, Atlanta.


Subscribe to our weekly newsletter

Get the latest scientific articles on interventional cardiology

More articles by this author

SMART-CHOICE 3 | Efficacy and Safety of Clopidogrel vs Aspirin Monotherapy in High Risk Patients after Percutaneous Coronary Intervention

Courtesy of Dr. Juan Manuel Pérez. After post percutaneous coronary intervention (PCI) standard duration dual antiplatelet therapy (DAPT), the optimal long term monotherapy strategy is...

Patients at High Risk of Bleeding After Coronary Angioplasty: Are Risk Assessment Tools ARC-HBR and PRECISE-DAPT Useful?

Patients undergoing coronary stenting typically receive dual antiplatelet therapy (DAPT) for 6 to 12 months, consisting of a P2Y12 receptor inhibitor and aspirin. While DAPT...

ACC-2025 Congress Second Day Key Studies

BHF PROTECT-TAVI (Kharbanda RK, Kennedy J, Dodd M, et al.)The largest randomized  trial carried out across 33 UK centers between 2020 and 2024, assessing...

ACC 2025 | API-CAT: Reduced vs. Full Dose Extended Anticoagulation in Patients with Cancer Related VTE

The risk of cancer related recurrent venous thromboembolism (VTE) will drop over time, while bleeding risk will persist. At present, it is recommended we...

LEAVE A REPLY

Please enter your comment!
Please enter your name here

Related Articles

SOLACI Sessionsspot_img

Recent Articles

Percutaneous Tricuspid Valve Replacement with Lux-Valve

Tricuspid regurgitation (TR) is a condition associated with poor quality of life, frequent hospitalizations due to heart failure, and increased mortality, even under optimal...

Transcatheter Pulmonary Valve Implantation with a Self-Expanding Valve: Outcomes at 3 Years

Pulmonary regurgitation (PR) is a common condition in patients who have undergone surgical repair of Tetralogy of Fallot or other pathologies involving the right...

Radial Patency in Coronary Procedures: Is Heparin Enough or Should We Aim for Distal Transradial Access?

Transradial access is the preferred route in most coronary procedures due to its proven reduction in mortality compared to transfemoral access. However, one of...