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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.|
Chang, Chun Chin
Wykrzykowska, Joanna J.
de Winter, Robbert J.
Steg, Philippe Gabriel
|Issue Date: ||2019|
|Publisher: ||OXFORD UNIV PRESS|
|Citation: ||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.|
|ISI #: ||000490151500010|
|Type: ||Journal Contribution|
|Appears in Collections: ||Research publications|
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