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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
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
European Heart Journal, Volume 40, No. 31, Year 2019
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Description
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 (Pinteraction = 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; Pinteraction = 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. © The Author(s) 2019.
Authors & Co-Authors
Serruys, Patrick W.
United Kingdom, London
Imperial College London
Tomaniak, Mariusz
Netherlands, Rotterdam
Erasmus Mc
Poland, Warsaw
Medical University of Warsaw
Modolo, Rodrigo G.P.
Netherlands, Amsterdam
Amsterdam Umc - University of Amsterdam
Brazil, Campinas
Universidade Estadual de Campinas
Soliman, O. I.I.
Netherlands, Rotterdam
Erasmus Mc
Netherlands, Rotterdam
Cardialysis bv
Wykrzykowska, Joanna J.
Netherlands, Amsterdam
Amsterdam Umc - University of Amsterdam
de Winter, Robbert Jan
Netherlands, Amsterdam
Amsterdam Umc - University of Amsterdam
Ferrario, Maurizio
Italy, Pavia
Fondazione Irccs Policlinico San Matteo
Bolognese, Leonardo
Italy, San Donato Milanese
Gruppo Ospedaliero San Donato
Stoll, Hans Peter
Unknown Affiliation
Hamm, Chrisitian Wilhelm
Germany, Bad Nauheim
Kerckhoff-klinik Gmbh
Steg, Philippe Gabriel
France, Paris
Ap-hp Assistance Publique - Hopitaux de Paris
Onuma, Yosinobu
Netherlands, Rotterdam
Erasmus Mc
Netherlands, Rotterdam
Cardialysis bv
Jüni, Peter
Canada, Toronto
Institute of Health Policy, Management and Evaluation
Windecker, Stephan W.
Switzerland, Bern
University of Bern
Vranckx, Pascal
Belgium, Hasselt
Hartcentrum Hasselt
Colombo, Antonio
Italy, Cotignola
Maria Cecilia Hospital
Valgimigli, Marco
Switzerland, Bern
University of Bern
Statistics
Citations: 88
Authors: 17
Affiliations: 19
Identifiers
Doi:
10.1093/eurheartj/ehz453
ISSN:
0195668X
Research Areas
Environmental
Health System And Policy
Noncommunicable Diseases
Study Design
Randomised Control Trial