Impact of ticagrelor monotherapy on two-year clinical outcomes in patients with long stenting: a post hoc analysis of the GLOBAL LEADERS trial.

Abstract

AIMS:

The aim of this study was to evaluate the impact of a novel antiplatelet regimen in patients with increasing total stent length (TSL).

METHODS AND RESULTS:

This is a post hoc analysis of the GLOBAL LEADERS trial, a prospective, multicentre, open-label, randomised trial, investigating the impact of the experimental strategy (one-month dual antiplatelet therapy [DAPT] followed by 23-month ticagrelor monotherapy) versus the reference regimen (12-month DAPT followed by 12-month aspirin monotherapy) in patients with a Biolimus A9-eluting stent (BES). The primary endpoint was the composite of all-cause death and new Q-wave myocardial infarction (MI), and the secondary endpoint was Bleeding Academic Research Consortium (BARC) type 3 or 5 bleeding at two years. To investigate the association between total stent length and outcomes, groups were compared in quartiles according to TSL; the fourth quartile group was at significantly higher ischaemic risk at two years. In that stratum (TSL ≥46 mm), the experimental strategy significantly reduced the risk of the primary endpoint (hazard ratio [HR] 0.67, 95% confidence interval [CI]: 0.49-0.90; pinteraction=0.043), while demonstrating a similar risk of BARC type 3 or 5 bleeding (HR 0.99, 95% CI: 0.66-1.49; pinteraction=0.975).

CONCLUSIONS:

Ticagrelor monotherapy could potentially balance ischaemic and bleeding risks, thereby achieving a net clinical benefit in patients with a TSL ≥46 mm with a BES.

• Authors: Kuniaki Takahashi, Ply Chichareon, Rodrigo Modolo, Norihiro Kogame, Chun Chin Chang, Mariusz Tomaniak, Aris Moschovitis, Nick Curzen, Michael Haude, Werner Jung, Lene Holmvang, Scot Garg, Jan G P Tijssen, Joanna J Wykrzykowska, Robbert J de Winter, Christian Hamm, Philippe Gabriel Steg, Hans-Peter Stoll, Yoshinobu Onuma, Marco Valgimigli, Pascal Vranckx, Stephan Windecker, Patrick W Serruys
• Journal: EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology (EuroIntervention) Vol. 16 Issue 8 Pg. 634-644 (Oct 23 2020) ISSN: 1969-6213 [Electronic] France
• PMID: 31498113 (Publication Type: Journal Article, Randomized Controlled Trial)

Chemical References

• Platelet Aggregation Inhibitors
• Ticagrelor

Topics

• Drug Therapy, Combination
• Drug-Eluting Stents
• Humans
• Percutaneous Coronary Intervention
• Platelet Aggregation Inhibitors (therapeutic use)
• Prospective Studies
• Stents
• Ticagrelor (therapeutic use)
• Treatment Outcome