Please use this identifier to cite or link to this item:
http://hdl.handle.net/1942/35761
Title: | Efficacy and Safety of Ticagrelor Monotherapy by Clinical Presentation: Pre‐Specified Analysis of the GLOBAL LEADERS Trial | Authors: | VRANCKX, Pascal Valgimigli, Marco Odutayo, Ayodele Serruys, Patrick W. Hamm, Christian Steg, Philippe Gabriel Heg, Dik Mc Fadden, Eugene P. Onuma, Yoshinobu BENIT, Edouard Janssens, Luc Diletti, Roberto Ferrario, Maurizio Huber, Kurt Raber, Lorenz Windecker, Stephan Juni, Peter |
Issue Date: | 2021 | Publisher: | WILEY | Source: | JOURNAL OF THE AMERICAN HEART ASSOCIATION, 10, (Art N° e015560) | Abstract: | BACKGROUND: The optimal duration of dual antiplatelet therapy after coronary drug-eluting stent placement in adults with stable coronary artery disease (SCAD) versus acute coronary syndromes (ACS) remains uncertain. METHODS AND RESULTS: This was a prespecified subgroup analysis of the GLOBAL LEADERS trial. Participants were randomly assigned 1:1 to the experimental or reference strategy, stratified by ACS (experimental, n=3750; reference, n=3737) versus SCAD (experimental, n=4230; reference, n=4251). The experimental strategy was 75 to 100 mg aspirin daily plus 90 mg ticagrelor twice daily for 1 month, followed by 23 months of ticagrelor monotherapy. The reference strategy was 75 to 100 mg aspirin daily plus either 75 mg clopidogrel daily (for SCAD) or 90 mg ticagrelor twice daily (for ACS) for 12 months, followed by aspirin monotherapy for 12 months. The primary end point at 2 years was a composite of all-cause mortality or non-fatal centrally adjudicated new Q-wave myocardial infarction. The key secondary safety end point was site-reported Bleeding Academic Research Consortium grade 3 or 5 bleeding. The primary end point occurred in 147 (3.92%) versus 169 (4.52%) patients with ACS (rate ratio [RR], 0.86; 95% CI, 0.69-1.08; P=0.189), and in 157 (3.71%) versus 180 (4.23%) patients with SCAD (RR, 0.87; 95% CI, 0.71-1.08; P=0.221) with experimental and reference strategy, respectively (P-interaction=0.926). Bleeding Academic Research Consortium grade 3 or 5 bleeding occurred in 73 (1.95%) versus 100 (2.68%) patients with ACS (RR, 0.73; 95% CI, 0.54-0.98; P=0.037), and in 90 (2.13%) versus 69 (1.62%) patients with SCAD (RR, 1.32; 95% CI, 0.97-1.81; P=0.081; P-interaction=0.007). CONCLUSIONS: While there was no evidence for differences in efficacy between treatment strategies by subgroup, the experimental strategy appeared to reduce bleeding risk in patients with ACS but not in patients with SCAD. | Notes: | Juni, P (corresponding author), Univ Toronto, Canada Res Chair Clin Epidemiol Chron Dis, St Michaels Hosp, Dept Med,Appl Hlth Res Ctr AHRC,Li Ka Shing Knowl, 30 Bond St, Toronto, ON M5B 1W8, Canada.; Juni, P (corresponding author), Univ Toronto, Canada Res Chair Clin Epidemiol Chron Dis, Li Ka Shing Knowledge Inst,St Michaels Hosp, Inst Hlth Policy Management & Evaluat,Appl Hlth R, 30 Bond St, Toronto, ON M5B 1W8, Canada. peter.juni@utoronto.ca |
Keywords: | acute coronary syndrome; all-corners; antiplatelet therapy; coronary;;intervention; stable coronary artery disease; ticagrelor | Document URI: | http://hdl.handle.net/1942/35761 | e-ISSN: | 2047-9980 | DOI: | 10.1161/JAHA.119.015560 | ISI #: | WOS:000697508400027 | Rights: | © 2021 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made. | Category: | A1 | Type: | Journal Contribution |
Appears in Collections: | Research publications |
Files in This Item:
File | Description | Size | Format | |
---|---|---|---|---|
JAHA.119.015560.pdf | Published version | 1.31 MB | Adobe PDF | View/Open |
WEB OF SCIENCETM
Citations
18
checked on Apr 23, 2024
Page view(s)
16
checked on Mar 4, 2022
Google ScholarTM
Check
Altmetric
Items in DSpace are protected by copyright, with all rights reserved, unless otherwise indicated.