Age and antiplatelet de-escalation after myocardial infarction in the TALOS-AMI trial

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 (<i>p</i> for interaction = 0.978), MACE (<i>p</i> = 0.585), or BARC bleeding (<i>p</i> = 0.597). Among patients aged ≥75 years, 14/18 bleeding events occurred within 180 days.</p> <p>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.</p> <p><b>Trial registration:</b> ClinicalTrials.gov (NCT02018055).</p> <p>In this prespecified secondary analysis of the TALOS-AMI trial, clopidogrel-based de-escalation was associated with lower risks of the primary net clinical endpoint and BARC type 2, 3, or 5 bleeding among patients aged <75 years, while MACE did not differ significantly between treatment strategies.

Among patients aged ≥75 years, no statistically significant between-group differences were observed for the primary net clinical endpoint, MACE, or BARC type 2, 3, or 5 bleeding. No statistically significant treatment-by-age interaction was detected using the prespecified 75 years cutoff, alternative 65 and 70 years cutoffs, or age as a continuous variable; the efficacy and safety of de-escalation specifically in older adults remain uncertain.</p>