Impact of long-term ticagrelor monotherapy following 1-month dual antiplatelet therapy in patients who underwent complex percutaneous coronary intervention: insights from the Global Leaders trial.
Journal article

Impact of long-term ticagrelor monotherapy following 1-month dual antiplatelet therapy in patients who underwent complex percutaneous coronary intervention: insights from the Global Leaders trial.

  • Serruys PW National Heart and Lung Institute, Imperial College London, Guy Scadding Building, Dovehouse St, Chelsea, London, UK.
  • Takahashi K Department of Cardiology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, AZ, Amsterdam, The Netherlands.
  • Chichareon P Department of Cardiology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, AZ, Amsterdam, The Netherlands.
  • Kogame N Department of Cardiology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, AZ, Amsterdam, The Netherlands.
  • Tomaniak M Department of Cardiology, Erasmus Medical University Center, Thorax Centre, Molewaterplein 40, GD Rotterdam, The Netherlands.
  • Modolo R Department of Cardiology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, AZ, Amsterdam, The Netherlands.
  • Chang CC Department of Cardiology, Erasmus Medical University Center, Thorax Centre, Molewaterplein 40, GD Rotterdam, The Netherlands.
  • Komiyama H Department of Cardiology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, AZ, Amsterdam, The Netherlands.
  • Soliman O Department of Cardiology, Erasmus Medical University Center, Thorax Centre, Molewaterplein 40, GD Rotterdam, The Netherlands.
  • Wykrzykowska JJ Department of Cardiology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, AZ, Amsterdam, The Netherlands.
  • de Winter RJ Department of Cardiology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, AZ, Amsterdam, The Netherlands.
  • Ferrario M Department of Cardiology, Fondazione IRCCS Policlinico San Matteo, Viale Camillo Golgi, 19, Pavia PV, Italy.
  • Dominici M Department of Cardiology, Azienda Ospedaliera S. Maria, Viale Tristano di Joannuccio, Terni TR, Italy.
  • Buszman P Center for Cardiovascular Research and Development, American Heart of Poland, Sanatoryjna 1, Ustroń, Poland.
  • Bolognese L Cardiovascular Department, San Donato Hospital, Via Pietro Nenni, 20/22, 52100 Arezzo, Italy.
  • Tumscitz C Department of Cardiology, Azienda Ospedaliero Universitaria di Ferrara, Via Aldo Moro, 8, Cona FE, Italy.
  • Benit E Department of Cardiology and Critical Care Medicine, Hartcentrum Hasselt, Jessa Ziekenhuis, Stadsomvaart 11, 3500 Hasselt, Belgium and Faculty of Medicine and Life Sciences, University of Hasselt, Martelarenlaan 42, Hasselt, Belgium.
  • Stoll HP Biosensors Europe, Rue de Lausanne 29, Morges, Switzerland.
  • Hamm C Kerckhoff Clinic and Thoraxcenter of the University of Giessen, Benekestraße 2-8, Bad Nauheim, Germany.
  • Steg PG Université Paris-Diderot, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, INSERM U-1148, French Alliance for Cardiovascular Trials, Paris, France.
  • Onuma Y Department of Cardiology, Erasmus Medical University Center, Thorax Centre, Molewaterplein 40, GD Rotterdam, The Netherlands.
  • Jüni P Applied Health Research Centre, Li Ka Shing Knowledge Institute of St Michael's Hospital, Department of Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto, 209 Victoria St, Toronto, ON, Canada.
  • Windecker S Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 4, Bern, Switzerland.
  • Vranckx P Department of Cardiology and Critical Care Medicine, Hartcentrum Hasselt, Jessa Ziekenhuis, Stadsomvaart 11, 3500 Hasselt, Belgium and Faculty of Medicine and Life Sciences, University of Hasselt, Martelarenlaan 42, Hasselt, Belgium.
  • Colombo A Department of Cardiology, Maria Cecilia Hospital-GVM, Via Madonna di Genova, 1, Cotignola RA, Italy.
  • Valgimigli M Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 4, Bern, Switzerland.
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  • 2019-08-10
Published in:
  • European heart journal. - 2019
English AIMS
To evaluate the impact of an experimental strategy [23-month ticagrelor monotherapy following 1-month dual antiplatelet therapy (DAPT)] vs. a reference regimen (12-month aspirin monotherapy following 12-month DAPT) after complex percutaneous coronary intervention (PCI).


METHODS AND RESULTS
In the present post hoc analysis of the Global Leaders trial, the primary endpoint [composite of all-cause death or new Q-wave myocardial infarction (MI)] at 2 years was assessed in patients with complex PCI, which includes at least one of the following characteristics: multivessel PCI, ≥3 stents implanted, ≥3 lesions treated, bifurcation PCI with ≥2 stents, or total stent length >60 mm. In addition, patient-oriented composite endpoint (POCE) (composite of all-cause death, any stroke, any MI, or any revascularization) and net adverse clinical events (NACE) [composite of POCE or Bleeding Academic Research Consortium (BARC) Type 3 or 5 bleeding] were explored. Among 15 450 patients included in this analysis, 4570 who underwent complex PCI had a higher risk of ischaemic and bleeding events. In patients with complex PCI, the experimental strategy significantly reduced risks of the primary endpoint [hazard ratio (HR): 0.64, 95% confidence interval (CI): 0.48-0.85] and POCE (HR: 0.80, 95% CI: 0.69-0.93), but not in those with non-complex PCI (Pinteraction = 0.015 and 0.017, respectively). The risk of BARC Type 3 or 5 bleeding was comparable (HR: 0.97, 95% CI: 0.67-1.40), resulting in a significant risk reduction in NACE (HR: 0.80, 95% CI: 0.69-0.92; Pinteraction = 0.011).


CONCLUSION
Ticagrelor monotherapy following 1-month DAPT could provide a net clinical benefit for patients with complex PCI. However, in view of the overall neutral results of the trial, these findings of a post hoc analysis should be considered as hypothesis generating.
Language
  • English
Open access status
closed
Identifiers
Persistent URL
https://sonar.ch/global/documents/131706
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