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Impact of Ticagrelor Monotherapy on Two-Year Clinical Outcomes in Patients with Long Stenting: A Post Hoc Analysis of the Global Leaders Trial

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  • 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
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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.

Original languageEnglish
JournalEuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology
Volume16
Issue number8
Pages (from-to)634-644
Number of pages11
ISSN1774-024X
DOIs
Publication statusPublished - 23 Oct 2020

    Research areas

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

ID: 59127056