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TOPLINE:

De-escalating from aspirin plus ticagrelor to aspirin plus clopidogrel 1 month post-percutaneous coronary intervention (PCI) was associated with favorable outcomes in patients with stabilized acute myocardial infarction (AMI) having a body mass index (BMI) less than 28 but not in those with a higher BMI.

METHODOLOGY:

• This post hoc analysis of the TALOS-AMI study performed in South Korea examined the association between BMI and outcomes after switching from ticagrelor to clopidogrel in 2686 patients with AMI who underwent PCI and whose BMI data were available (mean age, 60 years; 83.2% men).
• Participants received aspirin plus ticagrelor for 1 month after PCI. Stabilized patients without ischemic or severe bleeding complications were randomly assigned to receive aspirin plus clopidogrel (de-escalation strategy) or continue aspirin plus ticagrelor (active control strategy) for an additional 11 months.
• The patients were stratified into those with BMI < 28 and those with BMI ≥ 28.
• The primary endpoint was major adverse cardiovascular events (MACE) — a composite of cardiovascular death, MI, stroke, and bleeding type 2, 3, or 5 events according to the Bleeding Academic Research Consortium (BARC) criteria assessed at 12 months.

TAKEAWAY:

• In patients with BMI < 28, MACE occurred less frequently with the de-escalation strategy vs the active control strategy (adjusted hazard ratio [aHR], 0.54; P < .001).
• The difference in MACE was driven by a lower incidence of BARC type 2, 3, and 5 bleeding in the de-escalation group than in the active control group in patients with BMI < 28 (aHR, 0.47; P < .001).
• There was no significant difference in outcomes for either strategy in patients with BMI ≥ 28.
• No significant differences in all-cause mortality, MI, ischemic-driven revascularization, or stent thrombosis were observed between the de-escalation and active control strategies in either BMI group.

IN PRACTICE:

“Findings from this post hoc analysis of the TALOS-AMI study suggest that the outcomes associated with de-escalation strategies vary by BMI, with the greatest impact of de-escalation seen in those with lower BMIs. The BMI threshold of 28 should be cautiously interpreted,” the authors wrote, noting that Asian patients have lower BMIs on average compared with other ethnic groups.

SOURCE:

This study was led by Seonghyeon Bu, MD, of the College of Medicine at The Catholic University of Korea in Seoul, Republic of Korea. It was published online on February 27 in JAMA Network Open.

LIMITATIONS: 

As a post hoc analysis of the TALOS-AMI trial, the findings might not represent all the patients undergoing PCI for AMI. The BMI of patients was assessed at baseline only without accounting for potential changes in it during follow-up. Moreover, the relatively small sample size of the group with BMI ≥ 28 made it challenging to support this threshold value of 28.

DISCLOSURES:

The authors reported no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.