Abstract 4142197: Abbreviated Ticagrelor-Based Dual Antiplatelet Therapy in Acute Coronary Syndrome: A Systematic Review and Meta-Analysis

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Introduction: Few randomized clinical trials (RCTs) have evaluated the safety and efficacy of abbreviated Ticagrelor-based dual antiplatelet therapy (DAPT) in acute coronary syndrome (ACS); however, these RCTs were underpowered to detect differences in hard clinical outcomes. Research Question: What effect does abbreviated Ticagrelor-based DAPT have on risk of ischemic and bleeding events in ACS? Methods: A systematic search of MEDLINE, Cochrane, and Scopus databases was performed through 05/2024, for trials that compared abbreviated (≤ 3-months) versus standard 12-months Ticagrelor-based DAPT in ACS. The primary endpoint was all-cause mortality. Endpoints were measured at 12-months after DAPT initiation. Data were pooled using random-effects model. Heterogeneity was assessed via Chi-squared and Higgin’s I 2 test. RevMan 5.0 (Cochrane Collaboration, Oxford, United Kingdom) was utilized to perform statistical analysis. Results: Five trials were included in this analysis with 21,407 patients assessed. ULTIMATE-DAPT, T-PASS, and GLOBAL LEADERS-ACS assessed 1-month DAPT duration while TICO and TWILIGHT-ACS assessed 3-months DAPT duration. The average age was 62.7 years and 22.7% were women. Hypertension (61.7%), dyslipidemia (49.9%), diabetes (27.8%), and chronic kidney disease (12.7%) were the most common comorbidities. ACS presentations included NSTEMI (40.1%), unstable angina (35.2%), and STEMI (31.5%). Abbreviated Ticagrelor-based DAPT was associated with lower risk of all-cause mortality (RR 0.78; 95% CI 0.62-0.98, I 2 =0%) compared with standard duration DAPT. There was no differences between groups in cardiovascular death (RR 0.65; 95% CI 0.41-1.03, I 2 =0%), myocardial infarction (RR 1.04; 95% CI 0.85-1.27, I 2 =0%), stent thrombosis (RR 0.97; 95% CI 0.64-1.45, I 2 =0%), or ischemic stroke (RR 0.90; 95% CI 0.62-1.30, I 2 =0%). Abbreviated DAPT duration was associated with lower risk of major bleeding (RR 0.50; 95% CI 0.38-0.66, I 2 =46%). Conclusion: Our analysis includes the totality of randomized data evaluating the merits of abbreviated Ticagrelor-based DAPT after ACS. The salient study finding was the observed reduced risk of all-cause mortality with abbreviated DAPT approach, which was driven by reduced bleeding risk.