Kim BG, Hong SJ, Kim BK, et al. - In patients experiencing acute coronary syndrome, findings revealed an age‐dependent increase in the benefit of ticagrelor monotherapy after 3‐month dual‐antiplatelet therapy (DAPT) compared with ticagrelor‐based 12‐month DAPT. Ticagrelor monotherapy after short‐term DAPT might represent a more optimal choice than ticagrelor‐based 12‐month DAPT for elderly patients with acute coronary syndrome.

• This is a post hoc analysis from the TICO trial (Ticagrelor Monotherapy After 3 Months in the Patients Treated With New Generation Sirolimus‐eluting Stent for Acute Coronary Syndrome), wherein 3,056 patients with acute coronary syndrome (median age, 61 years) were randomized to the ticagrelor monotherapy after 3‐month DAPT group or ticagrelor‐based 12‐month DAPT group.

• A composite of major bleeding, death, myocardial infarction, stent thrombosis, stroke, or target‐vessel revascularization was defined as the primary endpoint.

• The risk attenuation impact of ticagrelor monotherapy following 3‐month DAPT vs ticagrelor‐based 12‐month DAPT on the primary endpoint was shown to slowly increase with age and was more pronounced from the subpopulation of age 64 years with the change point.

• The cutoff age for discriminating cases with greater advantage from this strategy was also ascertained.

• With this cutoff value of 64 years, a significantly lower occurrence of the primary endpoint was noted in the ticagrelor monotherapy after 3‐month DAPT group vs in the ticagrelor‐based 12‐month DAPT group (4.4% vs 9.0%) among patients aged ≥64 years (n=1278).

• However, it was not different in patients aged <64 years (n=1778) with a significant interaction (P‐interaction=0.036).