TY - JOUR JO - EuroIntervention TI - Single antiplatelet therapy directly after percutaneous coronary intervention in non-ST-segment elevation acute coronary syndrome patients: the OPTICA study AB - <p><strong>Background:</strong> Early P2Y<sub>12</sub> inhibitor monotherapy has emerged as a promising alternative to 12 months of dual antiplatelet therapy following percutaneous coronary intervention (PCI).</p> <p><strong>Aims:</strong> In this single-arm pilot study, we evaluated the feasibility and safety of ticagrelor or prasugrel monotherapy directly following PCI in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS).</p> <p><strong>Methods:</strong> Patients received a loading dose of ticagrelor or prasugrel before undergoing platelet function testing and subsequent PCI using new-generation drug-eluting stents. The stent result was adjudicated with optical coherence tomography in the first 35 patients. Ticagrelor or prasugrel monotherapy was continued for 12 months. The primary ischaemic endpoint was the composite of all-cause mortality, myocardial infarction, definite or probable stent thrombosis or stroke within 6 months. The primary bleeding endpoint was Bleeding Academic Research Consortium type 2, 3 or 5 bleeding within 6 months.</p> <p><strong>Results:</strong> From March 2021 to March 2022, 125 patients were enrolled, of whom 75 ultimately met all in- and exclusion criteria (mean age 64.5 years, 29.3% women). Overall, 70 out of 75 (93.3%) patients were treated with ticagrelor or prasugrel monotherapy directly following PCI. The primary ischaemic endpoint occurred in 3 (4.0%) patients within 6 months. No cases of stent thrombosis or spontaneous myocardial infarction occurred. The primary bleeding endpoint occurred in 7 (9.3%) patients within 6 months.</p> <p><strong>Conclusions:</strong> This study provides first-in-human evidence that P2Y<sub>12</sub> inhibitor monotherapy directly following PCI for NSTE-ACS is feasible, without any overt safety concerns, and highlights the need for randomised controlled trials comparing direct P2Y<sub>12</sub> inhibitor monotherapy with the current standard of care.</p> AU - van der Sangen Niels M.R. AU - Claessen E.P.M. Bimmer AU - Küçük I. Tarik AU - den Hartog W. Alexander AU - Baan Jan AU - Beijk A.M. Marcel AU - Delewi Ronak AU - van de Hoef Tim P. AU - Knaapen Paul AU - Lemkes S. Jorrit AU - Marques M. Koen AU - Nap Alexander AU - Verouden Niels J.W. AU - Vis M. Marije AU - de Winter J. Robbert AU - Kikkert Wouter J. AU - Appelman Yolande AU - Henriques P.S. Jose VL - IS - Y1 - 03/02/2023 Y1 - 2023 DOI - 10.4244/EIJ-D-22-00886 SP - KW - acs/nste-acs KW - adjunctive pharmacotherapy KW - bleeding KW - myocardial infarction KW - stent thrombosis PB - Europa Digital & Publishing UR - https://eurointervention.pcronline.com/article/single-antiplatelet-therapy-directly-after-percutaneous-coronary-intervention-in-non-st-segment-elevation-acute-coronary-syndrome-patients-the-optica-study SN - 1774-024X ER -