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oai:figshare.com:article/34037030 2026-09-30T22:00:02Z category_7 category_16 category_21 category_106 category_132 category_134 portal_87 item_type_6 month_year_09_2026

Age and antiplatelet de-escalation after myocardial infarction in the TALOS-AMI trial Seonghyeon Bu (13860647) Jaehyuk Jang (20418404) Sang Hyun Kim (8720874) Jaeho Byeon (16726928) Kwan Yong Lee (8525880) Gyu-Chul Oh (25146470) Sungmin Lim (7610090) Eun Ho Choo (5503682) Ik Jun Choi (11843185) Byung-Hee Hwang (8525886) Chan Joon Kim (8525874) Mahn-Won Park (6061538) Kiyuk Chang (3620258) Medicine Physiology Biotechnology Science Policy Infectious Diseases Virology De-escalation percutaneous coronary intervention P2Y12 inhibitors <p>The clinical effects of dual antiplatelet therapy de-escalation after acute myocardial infarction may differ by age. We evaluated whether the efficacy and safety of de-escalation from ticagrelor to clopidogrel differed by age in stabilized patients after percutaneous coronary intervention (PCI).</p> <p>This was a prespecified secondary analysis of the TALOS-AMI randomized trial. Patients event-free 1 month after PCI receiving aspirin–ticagrelor were randomly allocated to de-escalation (aspirin–clopidogrel) or continuation (aspirin–ticagrelor). The primary net clinical endpoint was a composite of major adverse cardiovascular events (cardiovascular death, myocardial infarction, stroke) and Bleeding Academic Research Consortium types 2, 3, or 5 bleeding at 1 year.</p> <p>We included 2697 participants (mean age 60.0 ± 11.4 years; 16.8% women). Among patients aged <75 years (<i>n</i> = 2376), de-escalation reduced the primary net clinical endpoint (4.1% vs. 7.2%; adjusted hazard ratio (aHR), 0.54 [95% CI, 0.38–0.77]) and bleeding (2.8% vs. 4.9%; aHR, 0.54 [0.35–0.82]). Among patients aged ≥75 years, no significant differences were observed for the primary endpoint (6.4% vs. 11.6%; aHR0.54 [0.25–1.17]) or bleeding (3.2% vs. 7.9%; aHR, 0.41 [0.15–1.15]). Interaction testing showed no treatment effect modification by age for the primary endpoint (<i>p</i> for interaction = 0.978), MACE (<i>p</i> = 0.585), or BARC bleeding (<i>p</i> = 0.597). Among patients aged ≥75 years, 14/18 bleeding events occurred within 180 days.</p> <p>Among stabilized, event-free patients 1 month after PCI, no significant age–treatment interaction was observed; therefore, the efficacy and safety of de-escalation in older adults (≥75 years) remain uncertain.</p> <p><b>Trial registration:</b> ClinicalTrials.gov (NCT02018055).</p> <p>In this prespecified secondary analysis of the TALOS-AMI trial, clopidogrel-based de-escalation was associated with lower risks of the primary net clinical endpoint and BARC type 2, 3, or 5 bleeding among patients aged <75 years, while MACE did not differ significantly between treatment strategies. Among patients aged ≥75 years, no statistically significant between-group differences were observed for the primary net clinical endpoint, MACE, or BARC type 2, 3, or 5 bleeding. No statistically significant treatment-by-age interaction was detected using the prespecified 75 years cutoff, alternative 65 and 70 years cutoffs, or age as a continuous variable; the efficacy and safety of de-escalation specifically in older adults remain uncertain.</p> 2026-09-30T22:00:02Z Text Journal contribution 10.6084/m9.figshare.34037030.v1 https://figshare.com/articles/journal_contribution/Age_and_antiplatelet_de-escalation_after_myocardial_infarction_in_the_TALOS-AMI_trial/34037030 CC BY 4.0