Journal article
Efficacy and safety of one-month DAPT followed by 23-month ticagrelor monotherapy in patients undergoing proximal LAD stenting: Insights from the GLOBAL LEADERS trial.
- Takahashi K Department of Cardiology, Amsterdam Universities Medical Centers, Location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
- Wang R Depatment of Cardiology, Radboud University, Nijmegen, the Netherlands.
- Kawashima H Department of Cardiology, Amsterdam Universities Medical Centers, Location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
- Tomaniak M Department of Cardiology, Erasmus Medical University Center, Thorax Centre, Rotterdam, the Netherlands.
- Gao C Depatment of Cardiology, Radboud University, Nijmegen, the Netherlands.
- Ono M Department of Cardiology, Amsterdam Universities Medical Centers, Location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
- Hara H Department of Cardiology, Amsterdam Universities Medical Centers, Location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
- Wykrzykowska JJ Department of Cardiology, Amsterdam Universities Medical Centers, Location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
- de Winter RJ Department of Cardiology, Amsterdam Universities Medical Centers, Location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
- Werner N Department of Medicine II, Heart Center, University Hospital Bonn, Bonn, Germany.
- Teiger E University Hospital Henri Mondor, Créteil, France.
- Almeida M Hospital de Santa Cruz, Lisbon, Portugal.
- Barraud P Clinique des Dômes, Clermont-Ferrand, France.
- Lantelme P Hôpital de la Croix-Rousse, Lyon, France.
- Barlis P Northern Hospital, Epping, Australia; St. Vincent's Heart Centre, Fitzroy, Australia.
- Garg S Royal Blackburn Hospital, Blackburn, United Kingdom.
- Hamm C University of Giessen, Kerckhoff Heartand Thorax Center, Bad Nauheim, Germany.
- Steg PG FACT (French Alliance for Cardiovascular Trials), Université Paris-Diderot, Paris, France.
- Onuma Y Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland.
- Vranckx P Department of Cardiology and Critical Care Medicine, Hartcentrum Hasselt, Jessa, Ziekenhuis, Hasselt, Belgium, Faculty of Medicine and Life Sciences, University of Hasselt, Hasselt, Belgium.
- Windecker S Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
- Valgimigli M Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
- Serruys PW Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland. Electronic address: patrick.w.j.c.serruys@gmail.com.
- 2020-08-05
Published in:
- International journal of cardiology. - 2020
Drug-eluting stent
Dual antiplatelet therapy
Proximal left anterior artery descending artery
Ticagrelor monotherapy
English
BACKGROUNDS
Data on optimal antiplatelet therapy in patients undergoing stenting of the proximal left anterior descending artery (LAD) are limited.
METHODS
This is a post-hoc analysis of the GLOBAL LEADERS trial, a prospective, multi-center, randomized controlled trial, comparing the experimental strategy (1-month dual anti-platelet therapy [DAPT] followed by 23-month ticagrelor monotherapy) with the reference regimen (12-month DAPT followed by 12-month aspirin monotherapy) in relation to stenting of the proximal LAD. The primary endpoint was the composite of all-cause death or new Q-wave myocardial infarction (MI) and key secondary safety endpoint was Bleeding Academic Research Consortium (BARC) type 3 or 5 bleeding at two years.
RESULTS
Among 15,845 patients included in the analysis, 3823 (23.9%) patients underwent stenting of the proximal LAD, while 12,022 (75.2%) did not. In the proximal LAD stenting group, there was no significant difference in the risk of the primary endpoint between the two antiplatelet strategies (3.38% vs. 3.93%; hazard ratio [HR]:0.86; 95% CI:0.62-1.20; Pinteraction = 0.951). However, the risk of any MI (2.63% vs. 3.88%; HR:0.68; 95% CI:0.47-0.97; Pinteraction = 0.015) and any revascularization (7.84% vs. 9.94%; HR:0.78; 95% CI:0.63-0.97; Pinteraction = 0.058) was significantly lower in the experimental strategy group, while demonstrating a similar risk of BARC type 3 or 5 bleeding between the two antiplatelet strategies (1.93% vs. 1.99%; HR:0.98; 95% CI:0.62-1.54; Pinteraction = 0.981).
CONCLUSIONS
The present study showed patients having stenting to the proximal LAD could potentially benefit from the experimental strategy with lower ischaemic events without a trade-off in major bleeding at two years.
Data on optimal antiplatelet therapy in patients undergoing stenting of the proximal left anterior descending artery (LAD) are limited.
METHODS
This is a post-hoc analysis of the GLOBAL LEADERS trial, a prospective, multi-center, randomized controlled trial, comparing the experimental strategy (1-month dual anti-platelet therapy [DAPT] followed by 23-month ticagrelor monotherapy) with the reference regimen (12-month DAPT followed by 12-month aspirin monotherapy) in relation to stenting of the proximal LAD. The primary endpoint was the composite of all-cause death or new Q-wave myocardial infarction (MI) and key secondary safety endpoint was Bleeding Academic Research Consortium (BARC) type 3 or 5 bleeding at two years.
RESULTS
Among 15,845 patients included in the analysis, 3823 (23.9%) patients underwent stenting of the proximal LAD, while 12,022 (75.2%) did not. In the proximal LAD stenting group, there was no significant difference in the risk of the primary endpoint between the two antiplatelet strategies (3.38% vs. 3.93%; hazard ratio [HR]:0.86; 95% CI:0.62-1.20; Pinteraction = 0.951). However, the risk of any MI (2.63% vs. 3.88%; HR:0.68; 95% CI:0.47-0.97; Pinteraction = 0.015) and any revascularization (7.84% vs. 9.94%; HR:0.78; 95% CI:0.63-0.97; Pinteraction = 0.058) was significantly lower in the experimental strategy group, while demonstrating a similar risk of BARC type 3 or 5 bleeding between the two antiplatelet strategies (1.93% vs. 1.99%; HR:0.98; 95% CI:0.62-1.54; Pinteraction = 0.981).
CONCLUSIONS
The present study showed patients having stenting to the proximal LAD could potentially benefit from the experimental strategy with lower ischaemic events without a trade-off in major bleeding at two years.
- Language
-
- English
- Open access status
- closed
- Identifiers
-
- DOI 10.1016/j.ijcard.2020.07.042
- PMID 32750393
- Persistent URL
- https://sonar.ch/global/documents/46911
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