Age and antiplatelet de-escalation after myocardial infarction in the TALOS-AMI trial
In brief
Switching to clopidogrel lowered net events from 7.2% to 4.1% under age 75
In stabilized heart attack patients who were event-free one month after stenting, switching from ticagrelor to clopidogrel reduced the one-year combined rate of cardiovascular events and significant bleeding among those under 75; bleeding also fell. Results in patients 75 and older were not statistically conclusive, and there was no evidence that age changed the treatment effect, leaving the benefit in older adults uncertain.
- Journal
- Annals of medicine (Q1)
- Published
- 30 September 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Seonghyeon Bu, Jaehyuk Jang, Sang Hyun Kim, Jaeho Byeon, Kwan Yong Lee, Gyu-Chul Oh, et al.
- PMID
- 42815042
- DOI
- 10.1080/07853890.2026.2726716
Why clinicians should know about it
- Picked for Cardiology and Cardiovascular Medicine (top studies of the week, 4 October 2026): De‑escalation from ticagrelor to clopidogrel after MI, age‑specific analysis
Abstract
BACKGROUND: 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). PATIENTS AND METHODS: 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. RESULTS: We included 2697 participants (mean age 60.0 ± 11.4 years; 16.8% women). Among patients aged <75 years (n = 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 (p for interaction = 0.978), MACE (p = 0.585), or BARC bleeding (p = 0.597). Among patients aged ≥75 years, 14/18 bleeding events occurred within 180 days. CONCLUSIONS: 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. UNLABELLED: Trial registration: ClinicalTrials.gov (NCT02018055).
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.