Abstract 11099: Body Mass Index and Association With Unguided De-Escalation From Ticagrelor to Clopidogrel in the TALOS-AMI Trial

Abstract

Introduction: Potent antiplatelet therapy has a high bleeding risk after acute myocardial infarction, so de-escalation from ticagrelor to clopidogrel has recently been introduced. But, optimal de-escalation strategy according to BMI is unclear. Method In TALOS-AMI trial, patients with acute myocardial infarction receiving aspirin and ticagrelor after index percutaneous coronary intervention (PCI) were investigated. This post hoc study determined the efficacy and safety of de-escalation (clopidogrel plus aspirin) compared with active control (ticagrelor plus aspirin) across a range of patient BMIs. Results Among 2,686 randomized patients, 1,558 (58.0%) had 18.5 ≤BMI <25 kg/m2, 935 (34.8%) had 25 ≤ BMI < 30 kg/m2, and 154 (5.7%) had BMI ≥ 30 kg/m2. The combination of clopidogrel plus aspirin compared with ticagrelor plus aspirin reduced in the primary outcome led by bleeding events reduction, in 18.5 ≤BMI <25 kg/m2. For 18.5 ≤BMI <25 kg/m2: 4.3% vs. 7.9%; hazard ratio (HR): 0.516 (95% confidential interval [CI]: 0.334 to 0.797); 25 ≤ BMI <30 kg/m2: 4.9% vs. 7.1%; HR: 0.674 (95% CI: 0.389 to 1.166); BMI ≥30 kg/m2: 1.2% vs. 4.2%; HR: 0.284 (95% CI: 0.029 to 2.792). Conclusion In conclusion, our results suggest that in the patients of 18.5 kg/m2 ≤BMI <25 kg/m2, with acute myocardial infarction after index PCI, de-escalation strategy is better net clinical outcome, mainly by reducing the bleeding events. But, there are no differences between two groups BMI ≥25 kg/m2.