Objectives: The aim of this study was to compare ticagrelor monotherapy with dual-antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) with drug-eluting stents. Background: The role of abbreviated DAPT followed by an oral P2Y12 inhibitor after PCI remains uncertain. Methods: Two randomized trials, including 14,628 patients undergoing PCI, comparing ticagrelor monotherapy with standard DAPT on centrally adjudicated endpoints were identified, and individual patient data were analyzed using 1-step fixed-effect models. The protocol was registered in PROSPERO (CRD42019143120). The primary outcomes were the composite of Bleeding Academic Research Consortium type 3 or 5 bleeding tested for superiority and, if met, the composite of all-cause death, myocardial infarction, or stroke at 1 year, tested for noninferiority against a margin of 1.25 on a hazard ratio (HR) scale. Results: Bleeding Academic Research Consortium type 3 or 5 bleeding occurred in fewer patients with ticagrelor than DAPT (0.9% vs. 1.7%, respectively; HR: 0.56; 95% confidence interval [CI]: 0.41 to 0.75; p < 0.001). The composite of all-cause death, myocardial infarction, or stroke occurred in 231 patients (3.2%) with ticagrelor and in 254 patients (3.5%) with DAPT (HR: 0.92; 95% CI: 0.76 to 1.10; p < 0.001 for noninferiority). Ticagrelor was associated with lower risk for all-cause (HR: 0.71; 95% CI: 0.52 to 0.96; p = 0.027) and cardiovascular (HR: 0.68; 95% CI: 0.47 to 0.99; p = 0.044) mortality. Rates of myocardial infarction (2.01% vs. 2.05%; p = 0.88), stent thrombosis (0.29% vs. 0.38%; p = 0.32), and stroke (0.47% vs. 0.36%; p = 0.30) were similar. Conclusions: Ticagrelor monotherapy was associated with a lower risk for major bleeding compared with standard DAPT, without a concomitant increase in ischemic events.
Ticagrelor Monotherapy Versus Dual-Antiplatelet Therapy After PCI / Valgimigli, Marco; Mehran, Roxana; Franzone, Anna; Da Costa, Bruno R.; Baber, Usman; Piccolo, Raffaele; Mcfadden, Eùgene P.; Vranckx, Pascal; Angiolillo, Dominick J.; Leonardi, Sergio; Cao, Davide; Dangas, George D.; Mehta, Shamir R.; Serruys, Patrick W.; Gibson, C. Michael; Steg, Gabriel P.; Sharma, Samin K.; Hamm, Christian; Shlofmitz, Richard; Liebetrau, Christoph; Briguori, Carlo; Janssens, Luc; Huber, Kurt; Ferrario, Maurizio; Kunadian, Vijay; Cohen, David J.; Zurakowski, Aleksander; Oldroyd, Keith G.; Yaling, Han; Dudek, Dariuz; Sartori, Samantha; Kirkham, Brian; Escaned, Javier; Heg, Dik; Windecker, Stephan; Pocock, Stuart; Jüni, Peter; Valgimigli, Marco; Mehran, Roxana; Windecker, Stephan; Vranckx, Pascal; Serruys, Patrick; Steg, Gabriel P.; Hamm, Christian; Baber, Usman; Angiolillo, Dominick J.; Cohen, David J.; Dangas, George D.; Mehta, Shamir; Gibson, Michael C.; Kastrati, Adnan; Krucoff, Mitchel; Ohman, Magnus E.; Gurbel, Paul; Henry, Timothy D.; Moliterno, David; Sharma, Samin K.; Pocock, Stuart; Jüni, Peter; Da Costa, Bruno R.; Kirkham, Brian; Sartori, Samantha; Heg, Dierik; Mcfadden, Eugene; Leonardi, Sergio; Piccolo, Raffaele; Franzone, Anna; Marx, Steven O.; Darrow, Bruce; Corvaja, Nicola; Destefano, Douglas; Ghodsi, Newsha; Meller, Jose; Franklin-Bond, Theresa; Cha, Jin Young; Waseem, Zaha; Jüni, Peter; Da Costa, Bruno R.; Kirkham, Brian; Huber, Kurt; Weisz, Giora; Kornowski, Ran; Kunadian, Vijay; Oldroyd, Keith; Yaling, Han; Kaul, Upendra; Witzenbichler, Bernhard; Dzavik, Vladimir; Gil, Robert; Dudek, Dariuz; Sardella, Gennaro; Escaned, Javier; Shlofmitz, Richard; Briguori, Carlo; Benit, Edouard; Liebetrau, Christoph; Janssens, Luc; Ferrario, Maurizio; Zurakowski, Aleksander; Diletti, Roberto; Dominici, Marcello; Huber, Kurt; Slagboom, Ton; Buszman, Paweł; Bolognese, Leonardo; Tumscitz, Carlo; Bryniarski, Krzysztof; Aminian, Adel; Vrolix, Mathias; Petrov, Ivo; Garg, Scot; Naber, Christoph; Prokopczuk, Janusz; Hamm, Christian; Steg, Philippe Gabriel; Windecker, Stephan. - In: JACC: CARDIOVASCULAR INTERVENTIONS. - ISSN 1936-8798. - 14:4(2021), pp. 444-456. [10.1016/j.jcin.2020.11.046]
Ticagrelor Monotherapy Versus Dual-Antiplatelet Therapy After PCI
Franzone, Anna;Piccolo, Raffaele;Piccolo, Raffaele;Franzone, Anna;
2021
Abstract
Objectives: The aim of this study was to compare ticagrelor monotherapy with dual-antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) with drug-eluting stents. Background: The role of abbreviated DAPT followed by an oral P2Y12 inhibitor after PCI remains uncertain. Methods: Two randomized trials, including 14,628 patients undergoing PCI, comparing ticagrelor monotherapy with standard DAPT on centrally adjudicated endpoints were identified, and individual patient data were analyzed using 1-step fixed-effect models. The protocol was registered in PROSPERO (CRD42019143120). The primary outcomes were the composite of Bleeding Academic Research Consortium type 3 or 5 bleeding tested for superiority and, if met, the composite of all-cause death, myocardial infarction, or stroke at 1 year, tested for noninferiority against a margin of 1.25 on a hazard ratio (HR) scale. Results: Bleeding Academic Research Consortium type 3 or 5 bleeding occurred in fewer patients with ticagrelor than DAPT (0.9% vs. 1.7%, respectively; HR: 0.56; 95% confidence interval [CI]: 0.41 to 0.75; p < 0.001). The composite of all-cause death, myocardial infarction, or stroke occurred in 231 patients (3.2%) with ticagrelor and in 254 patients (3.5%) with DAPT (HR: 0.92; 95% CI: 0.76 to 1.10; p < 0.001 for noninferiority). Ticagrelor was associated with lower risk for all-cause (HR: 0.71; 95% CI: 0.52 to 0.96; p = 0.027) and cardiovascular (HR: 0.68; 95% CI: 0.47 to 0.99; p = 0.044) mortality. Rates of myocardial infarction (2.01% vs. 2.05%; p = 0.88), stent thrombosis (0.29% vs. 0.38%; p = 0.32), and stroke (0.47% vs. 0.36%; p = 0.30) were similar. Conclusions: Ticagrelor monotherapy was associated with a lower risk for major bleeding compared with standard DAPT, without a concomitant increase in ischemic events.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
