Evaluation of Safety and Efficacy of Two Ticagrelor-based De-escalation Antiplatelet Strategies in Acute Coronary Syndrome

Inclusion Criteria: * diagnosis of STEMI or NSTEMI or unstable angina * for patients with STEMI, the following three inclusion criteria will have to be met: 1) new ST-elevation at the J-point in two contiguous leads with the cut-point ≥1 mm in all leads other than leads V2-V3, where the following cut-points apply: ≥2mm in men ≥40 years; ≥2.5 mm in men \<40 years, or ≥1.5 mm in women regardless of age; or a new left bundle-branch block 2) the intention to perform primary PCI 3) detection of a rise and/or fall of cardiac troponin values with at least one value above the 99th percentile upper reference limit * for patients with NSTEMI or unstable angina, at least two of the following three criteria will have to be met: 1. symptoms indicating myocardial ischaemia 2. ST-segment changes on electrocardiography indicating myocardial ischaemia 3. detection of a rise and/or fall of cardiac troponin values with at least one value above the 99th percentile upper reference limit in addition to at least one of the following: <!-- --> 1. ≥60 years of age; 2. previous MI or coronary artery by-pass grafting; 3. ≥50% stenosis in ≥2 coronary arteries; 4. previous ischaemic stroke or transient ischaemic attack; 5. ≥50% carotid stenosis or cerebral revascularisation; 6. diabetes mellitus; 7. peripheral artery disease; 8. chronic kidney disease with glomerular filtration rate \<60 mL/min. Exclusion Criteria: * contraindications to ticagrelor or/and aspirin * indications for oral anticoagulation therapy * second or third grade atrio-ventricular block * previous stent thrombosis on treatment with ticagrelor * end stage kidney disease with glomerular filtration rate \<15 mL/min or on haemodialysis * administration of prasugrel during the index event * pregnancy