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Title: Efficacy and Safety of Ticagrelor Monotherapy in Patients Undergoing Multivessel PCI
Authors: Takahashi, Kuniaki
Serruys, Patrick W.
Chichareon, Ply
Chang, Chun Chin
Tomaniak, Mariusz
Modolo, Rodrigo
Kogame, Norihiro
Magro, Michael
Chowdhary, Saqib
Eitel, Ingo
Zweiker, Robert
Ong, Paul
Ottesen, Michael Mundt
Tijssen, Jan G. P.
Wykrzykowska, Joanna J.
de Winter, Robbert J.
Garg, Scot
Stoll, Hans-Peter
Hamm, Christian
Steg, Philippe Gabriel
Onuma, Yoshinobu
Valgimigli, Marco
VRANCKX, Pascal 
Carrie, Didier
Windecker, Stephan
Issue Date: 2019
Abstract: BACKGROUND Data on optimal antiplatelet treatment regimens in patients who undergo multivessel percutaneous coronary intervention (PCI) are sparse. OBJECTIVES This post hoc study investigated the impact of an experimental strategy (1-month dual antiplatelet therapy [DAPT] followed by 23-month ticagrelor monotherapy) versus a reference regimen (12-month DAPT followed by 12-month aspirin monotherapy) according to multivessel PCI. METHODS The GLOBAL LEADERS trial is a prospective, multicenter, open-label, randomized controlled trial, allocating all-comer patients in a 1:1 ratio to either the experimental strategy or the reference regimen. The primary endpoint was the composite of all-cause death or new Q-wave myocardial infarction at 2 years. The secondary safety endpoint was Bleeding Academic Research Consortium type 3 or 5 bleeding. RESULTS Among the overall study population (n=15,845), 3,576 patients (22.4%) having multivessel PCI experienced a significantly higher risk of ischemic and bleeding events at 2 years, compared to those having single-vessel PCI. There was an interaction between the experimental strategy and multivessel PCI on the primary endpoint (hazard ratio: 0.62; 95% confidence interval: 0.44 to 0.88; p(interaction) = 0.031). This difference was largely driven by a lower risk of all-cause mortality. In contrast, the risk of Bleeding Academic Research Consortium type 3 or 5 bleeding was statistically similar between the 2 regimens (hazard ratio: 0.92; 95% confidence interval: 0.61 to 1.39; p(interaction) = 0.754). CONCLUSIONS Long-term ticagrelor monotherapy following 1-month DAPT can favorably balance ischemic and bleeding risks in patients with multivessel PCI. These findings should be interpreted as hypothesis-generating and need to be replicated in future dedicated randomized trials. (C) 2019 by the American College of Cardiology Foundation.
Notes: [Takahashi, Kuniaki; Chichareon, Ply; Modolo, Rodrigo; Kogame, Norihiro; Tijssen, Jan G. P.; Wykrzykowska, Joanna J.; de Winter, Robbert J.] Univ Amsterdam, Acad Med Ctr, Amsterdam, Netherlands. [Serruys, Patrick W.] Imperial Coll London, Int Ctr Circulatory Hlth, London, England. [Chichareon, Ply] Prince Songkla Univ, Dept Internal Med, Div Cardiol, Fac Med, Hat Yai, Thailand. [Chang, Chun Chin; Tomaniak, Mariusz; Onuma, Yoshinobu] Erasmus MC, Dept Cardiol, Thoraxctr, Rotterdam, Netherlands. [Tomaniak, Mariusz] Med Univ Warsaw, Dept Cardiol 1, Warsaw, Poland. [Modolo, Rodrigo] Univ Campinas UNICAMP, Cardiol Div, Dept Internal Med, Campinas, SP, Brazil. [Magro, Michael] TweeSteden Ziekenhuis, Tilburg, Netherlands. [Chowdhary, Saqib] Manchester Univ Fdn Trust, Manchester, Lancs, England. [Eitel, Ingo] Univ Heart Ctr Lubeck, Med Clin Cardiol Angiol Intens Care Med 1, Partner Site Hamburg Kiel Lubeck, Lubeck, Germany. [Eitel, Ingo] German Ctr Cardiovasc Res DZHK, Partner Site Hamburg Kiel Lubeck, Lubeck, Germany. [Zweiker, Robert] Med Univ Hosp Graz, Graz, Austria. [Ong, Paul] Tan Tock Seng Hosp, Singapore, Singapore. [Ottesen, Michael Mundt] Zealand Univ Hosp, Roskilde, Denmark. [Tijssen, Jan G. P.; Onuma, Yoshinobu] Cardialysis BV, Rotterdam, Netherlands. [Garg, Scot] Royal Blackburn Hosp, Blackburn, Lancs, England. [Stoll, Hans-Peter] Biosensors Clin Res, Morges, Switzerland. [Hamm, Christian] Univ Giessen, Bad Nauheim, Germany. [Hamm, Christian] Univ Giessen, Kerckhoff Heart & Thorax Ctr, Bad Nauheim, Germany. [Steg, Philippe Gabriel] Univ Paris Diderot, FACT, Paris, France. [Valgimigli, Marco; Windecker, Stephan] Univ Bern, Dept Cardiol, Inselspital, Bern, Switzerland. [Vranckx, Pascal] Hasselt Univ, Fac Med & Life Sci, Jessa Ziekenhuis, Hasselt, Belgium. [Carrie, Didier] Hop Rangueil, Toulouse, France.
Keywords: drug-eluting stent; dual antiplatelet therapy; multivessel percutaneous coronary intervention; ticagrelor monotherapy;drug-eluting stent; dual antiplatelet therapy; multivessel percutaneous coronary intervention; ticagrelor monotherapy
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ISSN: 0735-1097
e-ISSN: 1558-3597
DOI: 10.1016/j.jacc.2019.08.997
ISI #: 000489895000001
Rights: 2019 by the American College of Cardiology Foundation. Published by Elsevier.
Category: A1
Type: Journal Contribution
Validations: ecoom 2020
Appears in Collections:Research publications

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