Abstract
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.
| Original language | English (Ireland) |
|---|---|
| Pages (from-to) | 2595-2604 |
| Number of pages | 9 |
| Journal | Eur Heart J |
| Volume | 40 |
| Issue number | 31 |
| DOIs | |
| Publication status | Published - 1 Jan 2019 |
Keywords
- Complex percutaneous coronary intervention
- Drug-eluting stent
- Dual antiplatelet therapy
- Ticagrelor monotherapy
Authors (Note for portal: view the doc link for the full list of authors)
- Authors
- Serruys, P. W. and Takahashi, K. and Chichareon, P. and Kogame, N. and Tomaniak, M. and Modolo, R. and Chang, C. C. and Komiyama, H. and Soliman, O. and Wykrzykowska, J. J. and de Winter, R. J. and Ferrario, M. and Dominici, M. and Buszman, P. and Bolognese, L. and Tumscitz, C. and Benit, E. and Stoll, H. P. and Hamm, C. and Steg, P. G. and Onuma, Y. and Juni, P. and Windecker, S. and Vranckx, P. and Colombo, A. and Valgimigli, M.
