No Advantage Found In Modulating Antiplatelet Therapy Intensity After Complex Stenting

There was nary use to modulating nan strength of antiplatelet therapy compared pinch modular antiplatelet therapy successful high-risk patients who had undergone analyzable stenting procedures, according to late-breaking investigation presented successful a Hot Line convention coming astatine ESC Congress 2025.

Dual antiplatelet therapy (DAPT) consisting of aspirin positive a P2Y12 receptor inhibitor, specified arsenic clopidogrel, is mostly fixed to patients aft coronary stenting (percutaneous coronary involution [PCI]) to forestall ischemic events, specified arsenic bosom attacks (myocardial infarction). Principal Investigator, Professor Duk-Woo Park from Asan Medical Center, Seoul, South Korea, explained why nan TAILORED-CHIP proceedings was carried out: "The optimal antiplatelet therapy is not good established for patients who person undergone analyzable PCI procedures and are astatine precocious consequence of ischaemic events. We hypothesized that modulating nan strength of antiplatelet therapy complete time, i.e. stronger inhibition successful nan early shape to trim ischaemic events and weaker inhibition successful nan later shape to mitigate bleeding, whitethorn beryllium beneficial successful this high-risk population. The TAILORED-CHIP proceedings was designed to study whether early escalation pinch low-dose ticagrelor positive aspirin and precocious de-escalation pinch clopidogrel unsocial would beryllium amended than modular clopidogrel positive aspirin."

The open-label randomized TAILORED-CHIP proceedings was conducted astatine 24 sites successful South Korea. Patients pinch high-risk anatomical aliases objective characteristics undergoing analyzable PCI were enrolled and were randomized 1:1 to person tailored antiplatelet strategy consisting of early escalation (low-dose ticagrelor astatine 60 mg doubly regular positive aspirin for 6 months) past precocious de-escalation (clopidogrel monotherapy for 6 months) aliases modular DAPT (clopidogrel positive aspirin for 12 months).

The superior result was nett adverse objective events, defined arsenic a composite of decease from immoderate cause, myocardial infarction, stroke, stent thrombosis, unplanned urgent revascularization and clinically applicable bleeding (BARC type 2, 3, aliases 5) astatine 12 months. Prespecified secondary outcomes included awesome ischemic and clinically applicable bleeding events.

In total, 2,018 patients were enrolled. The mean property was 64.0 years and 17.1% were women. Most patients (93.7%) had PCI conducted successful astatine slightest 2 awesome bosom vessels during nan aforesaid procedure.

At 12 months, nan superior of result of nett adverse objective events was not importantly different betwixt nan groups, occurring successful 10.5% of patients assigned to tailored antiplatelet therapy and successful 8.8% of patients assigned to modular DAPT (hazard ratio [HR] 1.19; 95% assurance interval [CI] 0.90 to 1.58; p=0.21).

There was nary important quality successful nan incidence of awesome ischaemic events astatine 12 months betwixt nan tailored-therapy and DAPT groups (3.9% vs. 5.0%, respectively; HR 0.78; 95% CI 0.52 to 1.19; p=0.25). However, nan incidence of clinically applicable bleeding astatine 12 months was importantly higher successful nan tailored-therapy group (7.2%) compared pinch nan DAPT group (4.8%; absolute quality 2.45%; 95% CI 0.37% to 4.53%; p=0.002). The incidence of awesome bleeding was akin successful nan tailored-therapy group (1.7%) and nan DAPT group (1.5%; absolute quality 0.21%; 95% CI −0.89% to 1.31%; p=0.70).

Summarizing nan findings, Professor Park said: "Our results propose that a tailored strategy successful patients undergoing analyzable high-risk PCI does not supply a nett objective benefit. We observed an summation successful bleeding complications without a important simplification successful ischaemic events. This challenges nan conception that 'more is better' moreover successful cautiously selected patients astatine precocious ischemic consequence undergoing analyzable PCI procedures. Standard 12-month DAPT remains appropriate."