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Title: 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
Authors: Serruys, Patrick W.
Takahashi, Kuniaki
Chichareon, Ply
Kogame, Norihiro
Tomaniak, Mariusz
Modolo, Rodrigo
Chang, Chun Chin
Komiyama, Hidenori
Soliman, Osama
Wykrzykowska, Joanna J.
de Winter, Robbert J.
Ferrario, Maurizio
Dominici, Marcello
Buszman, Pawed
Bolognese, Leonardo
Tumscitz, Carlo
BENIT, Edouard 
Stoll, Hans-Peter
Hamm, Christian
Steg, Philippe Gabriel
Onuma, Yoshinobu
Juni, Peter
Windecker, Stephan
VRANCKX, Pascal 
Colombo, Antonio
Valgimigli, Marco
Issue Date: 2019
Source: EUROPEAN HEART JOURNAL, 40(31), p. 2595-+
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 (P-interaction = 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; P-interaction = 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.
Notes: [Serruys, Patrick W.] Imperial Coll London, Natl Heart & Lung Inst, Guy Scadding Bldg,Dovehouse St, London SW3 6LY, England. [Takahashi, Kuniaki; Chichareon, Ply; Kogame, Norihiro; Modolo, Rodrigo; Komiyama, Hidenori; Wykrzykowska, Joanna J.; de Winter, Robbert J.] Univ Amsterdam, Acad Med Ctr, Dept Cardiol, Meibergdreef 9, NL-1105 AZ Amsterdam, Netherlands. [Chichareon, Ply] Prince Songkla Univ, Fac Med, Dept Internal Med, Div Cardiol, 15 Karnjanavanich Rd, Hat Yai 90110, Songkhla, Thailand. [Tomaniak, Mariusz; Chang, Chun Chin; Soliman, Osama; Onuma, Yoshinobu] Erasmus Med Univ Ctr, Thorax Ctr, Dept Cardiol, Molewaterpl 40, NL-3015 GD Rotterdam, Netherlands. [Tomaniak, Mariusz] Med Univ Warsaw, Dept Cardiol 1, Zwirki i Wigury Str 61, PL-02091 Warsaw, Poland. [Modolo, Rodrigo] Univ Estadual Campinas, UNICAMP, Dept Internal Med, Cardiol Div, BR-13083970 Campinas, SP, Brazil. [Soliman, Osama; Onuma, Yoshinobu] Cardialysis BV, Westblaak 98, NL-3012 KM Rotterdam, Netherlands. [Ferrario, Maurizio] Fdn IRCCS Policlin San Matteo, Dept Cardiol, Viale Camillo Golgi 19, I-27100 Pavia, PV, Italy. [Dominici, Marcello] Azienda Osped S Maria, Dept Cardiol, Viale Tristano di Joannuccio, I-05100 Terni, TR, Italy. [Buszman, Pawed] Amer Heart Poland, Ctr Cardiovasc Res & Dev, Sanatoryjna 1, PL-43450 Ustron, Poland. [Buszman, Pawed] Med Univ Silesia, Dept Epidemiol & Stat, Poniatowskiego 15, PL-40055 Katowice, Poland. [Bolognese, Leonardo] San Donato Hosp, Cardiovasc Dept, Via Pietro Nenni 20-22, I-52100 Arezzo, Italy. [Tumscitz, Carlo] Azienda Osped Univ Ferrara, Dept Cardiol, Via Aldo Moro 8, I-44124 Cona, FE, Italy. [Benit, Edouard; Vranckx, Pascal] Jessa Ziekenhuis, Dept Cardiol & Crit Care Med, Hartctr Hasselt, Stadsomvaart 11, B-3500 Hasselt, Belgium. [Benit, Edouard; Vranckx, Pascal] Univ Hasselt, Fac Med & Life Sci, Martelarenlaan 42, Hasselt, Belgium. [Stoll, Hans-Peter] Biosensors Europe, Rue Lausanne 29, CH-1110 Morges, Switzerland. [Hamm, Christian] Univ Giessen, Kerckhoff Clin, Benekestr 2-8, D-61231 Bad Nauheim, Germany. [Hamm, Christian] Univ Giessen, Thoraxctr, Benekestr 2-8, D-61231 Bad Nauheim, Germany. [Steg, Philippe Gabriel] Univ Paris Diderot, French Alliance Cardiovasc Trials, INSERM U1148, Hop Bichat,AP HP, Paris, France. [Juni, Peter] Univ Toronto, Appl Hlth Res Ctr, Li Ka Shing Knowledge Inst, St Michaels Hosp,Dept Med, 209 Victoria St, Toronto, ON M5B 1T8, Canada. [Juni, Peter] Univ Toronto, Inst Hlth Policy Management, 209 Victoria St, Toronto, ON M5B 1T8, Canada. [Windecker, Stephan; Valgimigli, Marco] Univ Bern, Bern Univ Hosp, Dept Cardiol, Inselspital, Freiburgstr 4, CH-3010 Bern, Switzerland. [Colombo, Antonio] Maria Cecilia Hosp GVM, Dept Cardiol, Via Madonna di Genova 1, I-48033 Cotignola, RA, Italy.
Keywords: Complex percutaneous coronary intervention; Drug-eluting stent; Dual antiplatelet therapy; Ticagrelor monotherapy;Complex percutaneous coronary intervention; Drug-eluting stent; Dual antiplatelet therapy; Ticagrelor monotherapy
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ISSN: 0195-668X
e-ISSN: 1522-9645
DOI: 10.1093/eurheartj/ehz453
ISI #: 000490151500010
Rights: The Author(s) 2019. For permissions, please email:
Category: A1
Type: Journal Contribution
Validations: ecoom 2020
Appears in Collections:Research publications

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