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Title: | ‘Ticagrelor alone vs. dual antiplatelet therapy from 1 month after drug-eluting coronary stenting among patients with STEMI’: a post hoc analysis of the randomized GLOBAL LEADERS trial | Authors: | Gamal, Amr S. Hara, Hironori Tomaniak, Mariusz Lunardi, Mattia Gao, Chao Ono, Masafumi Kawashima, Hideyuki Juni, Peter VRANCKX, Pascal Windecker, Stephan Hamm, Christian Steg, Philippe Gabriel Onuma, Yoshinobu Serruys, Patrick W. |
Issue Date: | 2021 | Publisher: | OXFORD UNIV PRESS | Source: | EUROPEAN HART JOURNAL-ACUTE CARDIOVASCULAR CARE, 10 (7) , p. 756 -773 | Abstract: | Aim To evaluate the efficacy and safety of ticagrelor monotherapy beyond 1 month and up to 24months vs. standard 12-month dual antiplatelet therapy (DAPT) with aspirin and ticagrelor followed by aspirin monotherapy among ST-elevation myocardial infarction (STEMI) patients undergoing percutaneous coronary intervention (PCI) in the GLOBAL LEADERS trial. Methods and results We performed a post hoc analysis of STEMI patients in the GLOBAL LEADERS trial comparing experimental ticagrelor monotherapy (1062 patients) with standard 12-month DAPT (1030 patients). We evaluated predefined primary and secondary endpoints in both treatment arms. Rates of net adverse clinical events (NACE), patient-oriented composite endpoints (POCE), and bleeding academic research consortium (BARC)-defined bleeding Type 3 or 5 were also evaluated. At 2 years, there were no significant differences in rates of primary endpoints in patients who had STEMI [0.89 (0.61-1.31)]. There were similar rates of NACE and POCE in both experimental and reference treatment groups at 2years post-PCI [hazard ratio (HR) 0.96 (0.77-1.20) and 0.96 (0.77-1.21), respectively]. BARC 3 or 5 bleeding events were numerically less in experimental compared to reference treatment groups at 1 year [HR 0.55 (0.27-1.13)] and 2years [0.61 (0.32-1.16)]. Conclusion Presentation with STEMI has not influenced the incidence of GLOBAL LEADERS defined primary endpoints. There were no significant differences in rates of NACE, POCE, and BARC bleeding between the two treatment groups up to 2years of follow-up. Although these findings should be viewed as exploratory, they expand the evidence on potential safety of aspirin-free antiplatelet strategies after PCI in STEMI. | Notes: | Serruys, PW (corresponding author), Natl Univ Ireland, Dept Cardiol, Galway NUIG, Univ Rd, Galway H91 TK33, Ireland.; Serruys, PW (corresponding author), Imperial Coll London, Dept Cardiol, Exhibit Rd, London SW7 2BX, England. patrick.w.j.c.serruys@gmail.com |
Keywords: | STEMI; PCI; DAPT; Ticagrelor; GLOBAL LEADERS | Document URI: | http://hdl.handle.net/1942/35870 | DOI: | 10.1093/ehjacc/zuab033 | ISI #: | WOS:000715352600009 | Rights: | VC The Author(s) 2021. Published by Oxford University Press on behalf of the European Society of Cardiology. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com | Category: | A1 | Type: | Journal Contribution |
Appears in Collections: | Research publications |
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