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

Takahashi, Kuniaki, Chichareon, Ply, Modolo, Rodrigo, Kogame, Norihiro, Chang, Chun Chin, Tomaniak, Mariusz, Moschovitis, Aris, Curzen, Nick, Haude, Michael, Jung, Werner, Holmvang, Lene, Garg, Scot, Tijssen, Jan G P, Wykrzykowska, Joanna J, de Winter, Robbert J, Hamm, Christian, Steg, Philippe Gabriel, Stoll, Hans-Peter, Onuma, Yoshinobu, Valgimigli, Marco, Vranckx, Pascal, Windecker, Stephan and Serruys, Patrick W (2019) Impact of ticagrelor monotherapy on two-year clinical outcomes in patients with long stenting: a post hoc analysis of the global leaders trial. EuroIntervention, 40 (Supplement 1), [P2811]. (doi:10.4244/EIJ-D-19-00498).

Abstract

Background/Introduction: data on the efficacy and safety of different antiplatelet regimens are limited in patients with increasing total stent length (TSL).
Purpose: to evaluate the impact of the experimental strategy (1-month dual antiplatelet therapy [DAPT] followed by 23-month ticagrelor monotherapy) vs. the reference regimen (12-month DAPT followed by 12-month aspirin monotherapy) in patients with increasing TSL.
Methods: the present post-hoc analysis of the Global Leaders trial evaluated the primary endpoint (the composite of the all-cause death and new Q-wave myocardial infarction [MI]) at two years in patients with increasing TSL. In addition, the patient-oriented composite endpoint (POCE) (the composite of all-cause death, any stroke, any MI, and any revascularization) and the net adverse clinical events (NACE) (the composite of POCE and Bleeding Academic Research Consortium [BARC] type 3 or 5 bleeding) were also assessed.
Results: the cohort of 15,450 patients treated with a biolimus-eluting biodegradable polymer stents were included in this analysis. In the longer TSL group (≥46mm), the experimental strategy significantly reduced the risk of the primary endpoint (3.78% vs. 5.68%, hazard ratio (HR): 0.67, 95% confidence interval (CI): 0.49–0.90, p=0.008, P interaction=0.042) as well as POCE (14.57% vs. 18.11%, HR: 0.79, 95% CI: 0.67–0.92, p=0.003, P interaction=0.010) and NACE (16.07% vs. 19.64%, HR: 0.80, 95% CI: 0.69–0.93, p=0.004, P interaction=0.012) at two years. The risk of BARC type 3 or 5 bleeding at two years was similar between the two antiplatelet regimens.
Conclusion: ticagrelor monotherapy significantly reduced the risk of the primary endpoint, POCE and NACE with a similar risk of BARC type 3 or 5 bleeding at two years in patients with the longer TSL.

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Contributors

Author: Nick Curzen

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