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Title: | Clinical relevance of ticagrelor monotherapy following 1-month dual antiplatelet therapy after bifurcation percutaneous coronary intervention: Insight from GLOBAL LEADERS trial | Authors: | Kogame, Norihiro Chichareon, Ply De Wilder, Kenneth Takahashi, Kuniaki Modolo, Rodrigo Chang, Chun Chin Tomaniak, Mariusz Komiyama, Hidenori Chieffo, Alaide Colombo, Antonio Garg, Scot Louvard, Yves Juni, Peter Steg, Philippe G. Hamm, Christian VRANCKX, Pascal Valgimigli, Marco Windecker, Stephan Stoll, Hans-Peter Onuma, Yoshinobu Janssens, Luc Serruys, Patrick W. |
Issue Date: | 2020 | Publisher: | WILEY | Source: | CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, 96 (1), p. 100-111 | Abstract: | Background The aim of this study was to investigate the impact of ticagrelor monotherapy following 1-month dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) for bifurcation lesions. Methods GLOBAL LEADERS was a randomized, superiority, all-comers trial comparing 1-month DAPT with ticagrelor and aspirin followed by 23-month ticagrelor monotherapy (experimental treatment) with standard 12-month DAPT followed by 12-month aspirin monotherapy (reference treatment) in patients treated with a biolimus A9-eluting stent. The primary endpoint was a composite of all-cause death or new Q-wave myocardial infarction (MI) at 2 years. Results Among the 15,845 patients included in this subgroup analysis, 2,498 patients (15.8%) underwent PCI for at least one bifurcation lesion. The incidence of the primary endpoint was similar between the bifurcation and nonbifurcation groups (4.7 vs. 4.0%, p = .083). The experimental treatment had no significant effect on the primary endpoint according to the presence/absence of a bifurcation lesion (bifurcation: hazard ratio [HR]: 0.74, 95% confidence interval [CI]: 0.51-1.07; nonbifurcation: HR: 0.90, 95% CI: 0.76-1.07, p for interaction = .343), but was associated with significant reduction in definite or probable stent thrombosis (p for interaction = .022) and significant excess of stroke (p for interaction = .018) when compared with the reference treatment. Conclusions After PCI for bifurcation lesions using 1-month of DAPT followed by ticagrelor monotherapy for 23 months did not demonstrate explicit benefit regarding all-cause death or new Q-wave MI as in the overall trial. | Notes: | [Kogame, Norihiro; Chichareon, Ply; Takahashi, Kuniaki; Modolo, Rodrigo; Komiyama, Hidenori] Amsterdam Univ Med Ctr, Dept Cardiol, Amsterdam, Netherlands. [Kogame, Norihiro] Toho Univ, Dept Cardiol, Med Ctr, Ohashi Hosp, Tokyo, Japan. [Chichareon, Ply] Prince Songkla Univ, Fac Med, Dept Internal Med, Div Cardiol, Hat Yai, Thailand. [De Wilder, Kenneth; Janssens, Luc] Imelda Hosp Bonheiden, Heart Ctr, Bonheiden, Belgium. [Modolo, Rodrigo] Univ Estadual Campinas, UNICAMP, Dept Internal Med, Cardiol Div, Campinas, SP, Brazil. [Chang, Chun Chin; Tomaniak, Mariusz; Onuma, Yoshinobu] Erasmus MC, Thoraxctr, Dept Intervent Cardiol, Rotterdam, Netherlands. [Chieffo, Alaide] IRCCS San Raffaele Sci Inst, Intervent Cardiol Unit, Milan, Italy. [Colombo, Antonio] Villa Maria Cecila Hosp GVM, Intervent Cardiol Unit, Cotignola, RA, Italy. [Garg, Scot] Royal Blackburn Hosp, Dept Cardiol, Blackburn, Lancs, England. [Louvard, Yves] Hop Prive Jacques Cartier, Inst Cardiovasc Paris Sud, Ramsay Gen Sante, Dept Cardiol, Massy, France. [Juni, Peter] St Michaels Hosp, Li Ka Shing Knowledge Inst, Appl Hlth Res Ctr, Toronto, ON, Canada. [Juni, Peter] Univ Toronto, Dept Med, Toronto, ON, Canada. [Juni, Peter] Univ Toronto, Inst Hlth Policy Management & Evaluat, Toronto, ON, Canada. [Steg, Philippe G.] Univ Paris Diderot, FACT, Paris, France. [Hamm, Christian] Univ Giessen, Kerckhoff Heart & Thorax Ctr, Giessen, Germany. [Vranckx, Pascal] Jessa Ziekenhuis Hasselt Univ, Fac Med & Life Sci, Hasselt, Belgium. [Valgimigli, Marco; Windecker, Stephan] Univ Bern, Dept Cardiol, Inselspital, Bern, Switzerland. [Stoll, Hans-Peter] Biosensors Clin Res, Morges, Switzerland. [Serruys, Patrick W.] Imperial Coll London, Int Ctr Circulatory Hlth, London, England. | Keywords: | antiplatelet treatment;bifurcation lesion;drug-eluting stents;Percutaneous coronary intervention | Document URI: | http://hdl.handle.net/1942/29117 | ISSN: | 1522-1946 | e-ISSN: | 1522-726X | DOI: | 10.1002/ccd.28428 | ISI #: | 000480814500001 | Rights: | 2019 Wiley Periodicals, Inc. | Category: | A1 | Type: | Journal Contribution | Validations: | ecoom 2020 |
Appears in Collections: | Research publications |
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Bifurcation_GL_manuscript_with_Figure (5).pdf | Peer-reviewed author version | 1.57 MB | Adobe PDF | View/Open |
Cathet Cardio Intervent - 2019 - Kogame - Clinical relevance of ticagrelor monotherapy following 1‐month dual antiplatelet.pdf Restricted Access | Published version | 2.14 MB | Adobe PDF | View/Open Request a copy |
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