Low-dose Ticagrelor in Patients With High Ischemic Risk and Prior Myocardial Infarction: A Multicenter Prospective Real-World Observational Study

Prolonged dual antiplatelet therapy (DAPT) after 12 months in patients with prior myocardial infarction is attractive to reduce long-term ischemic complications. In the PEGASUS-TIMI 54, the use of low-dose ticagrelor (60 mg b.i.d.) plus aspirin after 12 months from myocardial infarction reduced the risk of ischemic events, at the price of limited increase on bleeding complications. However, data on the use of low-dose ticagrelor in real-world practice lack. We aim at providing data on prescription/eligibility criteria of and outcomes in patients receiving low-lose ticagrelor in the real-world setting. We enrolled consecutive patients eligible for ticagrelor 60 mg according to Italian national regulation in three high-volume centers, and collected 1-year outcomes. The primary objective of the study is to generate real-world data about clinical characteristics, eligibility criteria, major adverse cardiovascular events (MACE), bleeding, and adverse event in patients receiving low-dose ticagrelor from our cohort. One hundred eighty-one patients were consecutively enrolled with a median follow-up of 18 months. The most used and the least used prescription criteria were multivessel coronary disease (72.4%) and CKD (15.5%), respectively. At 1-year follow-up, the rate of MACE events was 4.97%; of these, 3.86% of patients had a myocardial infarction, and 1.1 % had a stroke/TIA, while no major bleeding occurred. In conclusion, in a real-world study including patients with prior myocardial infarction, low-dose ticagrelor for prolonged DAPT showed to be effective and safe, with no major bleeding occurring at follow-up.