Tico

1. TICO

2. TICO
Acronym: TICO
Description: Ticagrelor With or Without Aspirin in
Acute Coronary Syndrome After PCI

3. Source: https://www.acc.org/latest-in-cardiology/clinical-
trials/2020/03/27/22/47/tico
Presenters: Byeong-Keuk Kim, MD, PhD; Anthony A. Bavry, MD, MPH,
FACC; Deepak L. Bhatt, MD, MPH, FACC
Trial objective: To evaluate ticagrelor monotherapy after 3 months of dual
antiplatelet therapy (DAPT) compared with 12 months of DAPT after percutaneous
coronary intervention (PCI) for acute coronary syndrome (ACS).
TICO

4. Trial design: Randomized, Parallel, Stratification, Open-label
assessment.
Sample size: 3,056 individuals
Inclusion criteria: ACS treated with the ultrathin bioresorbable
polymer sirolimus-eluting stent (Orsiro); ≥19 years of age
Exclusion criteria: >80 years of age; Increased risk of bleeding; Need
for oral anticoagulation therapy; Current or potential pregnancy; Hepatic
dysfunction; Bradycardia
TICO

5. Methodology:
 Patients undergoing PCI for ACS were randomized to ticagrelor
monotherapy after 3 months of DAPT (n = 1,527) versus standard
therapy (n = 1,529).
 Individuals are followed up after 12 months
 Mean patient age is 61 years
 Percentage female is 21%
 27% percentage of individuals are with diabetes
TICO

6. Results:
Primary outcome:
 Net adverse clinical events (death, MI, stent thrombosis, stroke, target vessel
revascularization, or Thrombolysis in Myocardial Infarction [TIMI] major
bleeding) at 12 months, occurred in 3.9% of the ticagrelor monotherapy
after 3 months of DAPT group compared with 5.9% of the standard therapy
group (p = 0.01).
 Association of ticagrelor monotherapy after 3 months of DAPT vs. standard
therapy on the primary outcome:
o Overall hazard ratio (HR) = 0.66,
o No multivessel disease HR = 0.41,
o Multivessel disease HR = 0.86 (p for interaction = 0.04).
 Landmark analysis at 3 months for ticagrelor monotherapy vs. standard
therapy for the primary outcome: (HR 0.41, p = 0.001).
Continued….
TICO

7. Secondary Outcome:
 Major bleeding at 12 months: 1.7% of the ticagrelor monotherapy
after 3 months group compared with 3.0% of the standard therapy
group (p = 0.02)
 Stent thrombosis at 12 months: 0.4% of the ticagrelor monotherapy
after 3 months group compared with 0.3% of the standard therapy
group (p = 0.53)
 TICO-STEMI subgroup analysis: Major adverse cardiac and
cerebrovascular events at 12 months: 2.7% of the ticagrelor
monotherapy after 3 months group compared with 2.5% of the
standard therapy group (p = 0.81)
TICO

8. Conclusion:
 Among ACS patients who underwent PCI with an ultrathin
biodegradable-polymer sirolimus-eluting stent, ticagrelor
monotherapy after 3 months of DAPT was superior to standard
therapy of DAPT for 12 months.
 Ticagrelor monotherapy was effective at preventing net composite
ischemic and bleeding events.
 Ticagrelor monotherapy appears to be an emerging strategy,
especially for patients with increased bleeding risk, after a short
duration of DAPT.
TICO