Abstract 4146935: Ticagrelor Monotherapy in Patients with ACS Undergoing Coronary Stenting: An Updated Meta-Analysis of 3 Month versus 12 Month DAPT

Background: Current guidelines recommend DAPT for 12 months in patients with ACS undergoing PCI. However, data on ticagrelor monotherapy after early aspirin discontinuation (<3 months, Short-DAPT) is scarce. We conducted an updated meta-analysis to assess the safety and efficacy of < 3 month of DAPT (aspirin and ticagrelor) in patients with ACS undergoing PCI. Hypothesis: Short-DAPT will be more favorable than Standard-DAPT. Methods: This meta-analysis reviewed literature obtained systematically. Inclusion criteria encompassed randomized controlled trials of ticagrelor comparing < 3 month of DAPT with 12 month of DAPT in ACS patients undergoing coronary stenting with a minimum follow up of one year. The primary endpoint was major adverse cardiovascular events (MACE). Secondary outcomes were net adverse clinical events (NACE), all-cause mortality, and major bleeding. We estimated inverse variance pooled hazard ratios using a random-effects model and DerSimonian-Laird method to calculate between-study variance. Results: Five trials with 21407 patients of ACS undergoing PCI were included (FIGURE). When comparing Short-DAPT with Standard- DAPT, the pooled hazard ratios and corresponding 95% confidence intervals for MACE, NACE, all-cause mortality, and major bleeding were 0.90 (0.77, 1.06), 0.72 (0.57, 0.91), 0.76 (0.59, 0.99), and 0.44 (0.35, 0.56), respectively Conclusion: Patients with ACS undergoing PCI can benefit from superior clinical outcomes, lower bleeding rate and a similar rate of MACE, with aspirin discontinuation at or less than 3 months and maintenance on ticagrelor monotherapy afterwards.