Table 3.
Age-specific data in main randomized studies about de-escalation strategy.
| Unguided | ||||||
| Study | ACS Presentation (%) | PCI Rate (%) | Elderly Patients (%) | Groups |
Follow-Up
(m) |
Main Results |
| TALOS-AMI [55] | STEMI (54%), NSTEMI (46%) | 100% | ≥75 y (27%) | 1 m ticagrelor + ASA-> 11 m clopidogrel + ASA vs. 12 m ticagrelor + ASA |
12 | De-escalation strategy significantly reduced the risk of net clinical events, mainly by reducing the bleeding events. No treatment interaction by age was observed. |
| Guided | ||||||
| TROPICAL ACS [56,57] | STEMI (55.7%), NSTEMI (44.3%) | 100% | ≥70 y (14.2%) | 1w ASA + prasugrel -> 1 w ASA + clopidogrel -> 11.5 m ASA + prasugrel/ clopidogrel based on PFT vs. 12 m ASA + prasugrel |
12 | Guided de-escalation was non-inferior to standard treatment in terms of net clinical benefit. Age analysis revealed a significant clinical benefit in younger patients. |
| ANTARCTIC [58] | STEMI (34.4%), NSTEMI (65.6%) | 100% | ≥75 y (100%) | 2w ASA + prasugrel 5 mg -> change in P2Y12i based on PFT (prasugrel 5 mg or 10 mg/clopidogrel) vs. ASA + prasugrel |
12 | No significant difference in the composite endpoint of ischemic events and bleedings between the two groups. |
| POPULAR GENETIC [59] | STEMI (100%) | 100% | ≥75 y (14.6%) | ASA + P2Y12i based on genetic test (clopidogrel/prasugrel or ticagrelor) vs. ASA + prasugrel or ticagrelor |
12 | Guided de-escalation was non-inferior to standard treatment for thrombotic events and resulted in a lower incidence of bleeding. These findings were not found to depend on age category. |
m = months, y = years, PFT = platelet function test, P2Y12i = P2Y12 inhibitor.