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Title: | Ticagrelor monotherapy versus aspirin monotherapy at 12 months after percutaneous coronary intervention: a landmark analysis of the GLOBAL LEADERS trial | Authors: | Ono, Masafumi Hara, Hironori Kawashima, Hideyuki Gao, Chao Wang , Rutao Wykrzykowska, Joanna J. Piek, Jan J. Garg, Scot Hamm, Christian Steg, Philippe Gabriel Valgimigli, Marco Windecker, Stephan VRANCKX, Pascal Onuma, Yoshinobu Serruys, Patrick W. |
Issue Date: | 2022 | Publisher: | EUROPA EDITION | Source: | EuroIntervention, 18 (5) , p. E377 -+ | Abstract: | Background: The optimal antiplatelet strategy in the second year after percutaneous coronary intervention (PCI) remains unclear. Aims: We aimed to compare ticagrelor monotherapy with aspirin monotherapy on clinical outcomes be and 1 year post-PCI. Methods: This post hoc subanalysis of the open-label, all-corners, randomised GLOBAL LEADERS trial, which con pared 23-month ticagrelor monotherapy following 1-month dual antiplatelet therapy (DAPT) with 12-month aspirin monotherapy following 12-month DAPT, only included patients who, at 12 months, were free from ischaemic and bleeding events and were adherent to their assigned antiplatelet therapy. The incidences of ischaemic events (all-cause death, any myocardial infarction, or any stroke) and bleeding events (Bleeding Academic Research Consortium [BARC] type 3 or 5 bleeding) during the second year (12-24 months) were compared between patients receiving either ticagrelor or aspirin monotherapy. Results: The present analysis included 11,121 (ticagrelor monotherapy n=5,308, and aspirin monotherapy n=5,813) of the 15,991 patients enrolled in GLOBAL LEADERS. During the second year, the ischaemic composite endpoint was lower with ticagrelor monotherapy compared to aspirin monotherapy (1.9% vs 2.6%: log-rank p=0.014, adjusted hazard ratio [BR] 0.74, 95% confidence interval [CI]: 0.58-0.96; p=0.022), which was primarily driven by a reduced risk of myocardial infarction. In contrast, BARC type 3 or 5 bleeding was numerically higher with ticagrelor monotherapy (0.5% vs 0.3%: log-rank - 0.051, adjusted HR 1.89, 95% CI: 1.03-3.45; p=0.005). Conclusions: Patients free from events at the end of the first year post-PCI and who adhered to their prescribed regimen had a reduced risk of ischaemic events compared to aspirin monotherapy in the second year post-PCI. | Notes: | Serruys, PW (corresponding author), Natl Univ Ireland, Dept Cardiol, Univ Rd, Galway H91 TK33, Ireland. pairick.serruys@nuigalway.ie |
Keywords: | ACS/NSTE-ACS;adjunctive pharmacotherapy;drug-eluting stentst;able angina | Document URI: | http://hdl.handle.net/1942/39005 | ISSN: | 1774-024X | e-ISSN: | 1969-6213 | DOI: | 10.4244/EIJ-D-21-00870 | ISI #: | 000882974700005 | Rights: | Europa Digital & Publishing 2022. All rights reserved. | Category: | A1 | Type: | Journal Contribution | Validations: | ecoom 2023 |
Appears in Collections: | Research publications |
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Ticagrelor monotherapy.pdf Restricted Access | Peer-reviewed author version | 1.63 MB | Adobe PDF | View/Open Request a copy |
ticagrelor_monotherapy_versus_aspirin_monotherapy_at_12_months_after_percutaneou.pdf Restricted Access | Published version | 690.98 kB | Adobe PDF | View/Open Request a copy |
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