Early de-escalation of DAPT demonstrated clinically meaningful benefit in myocardial infarction (MI) with DM. A study in JACC: Cardiovascular Interventions evaluated whether DM modifies the effect of a one-month unguided switch from ticagrelor to clopidogrel following PCI.

This post hoc analysis included individuals with MI and DM from the TALOS-AMI (Ticagrelor Versus Clopidogrel in Stabilized Patients With Acute Myocardial Infarction) trial who had tolerated one month of ticagrelor-based DAPT after PCI. Participants were randomized to continue ticagrelor or transition to clopidogrel for eleven months. The primary endpoint combined ischemic outcomes, including cardiovascular death, MI, and stroke, with Bleeding Academic Research Consortium (BARC) type 2, 3, or 5 bleeding.

De-escalation was associated with a lower rate of the primary composite endpoint compared with continued ticagrelor therapy. Within the DM subgroup, reductions in bleeding and ischemic outcomes did not reach statistical significance. Treatment effects remained consistent across glycemic control categories and levels of PCI complexity. Interaction signals suggested differences in severe bleeding and repeat revascularization.

These findings indicate that one-month unguided de-escalation may offer a favorable balance between bleeding and ischemic risk in individuals with MI and DM. Further prospective validation is warranted.