Clinical relevance of ticagrelor monotherapy following 1-month dual antiplatelet therapy after bifurcation percutaneous coronary intervention: Insight from GLOBAL LEADERS trial

Norihiro Kogame, Ply Chichareon, Kenneth De Wilder, Kuniaki Takahashi, Rodrigo Modolo, Chun Chin Chang, Mariusz Tomaniak, Hidenori Komiyama, Alaide Chieffo, Antonio Colombo, Scot Garg, Yves Louvard, Peter Jüni, Philippe G. Steg, Christian Hamm, Pascal Vranckx, Marco Valgimigli, Stephan Windecker, Hans Peter Stoll, Yoshinobu OnumaLuc Janssens, Patrick W. Serruys

Research output: Contribution to journalArticlepeer-review

Abstract

Background: The aim of this study was to investigate the impact of ticagrelor monotherapy following 1-month dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) for bifurcation lesions. Methods: GLOBAL LEADERS was a randomized, superiority, all-comers trial comparing 1-month DAPT with ticagrelor and aspirin followed by 23-month ticagrelor monotherapy (experimental treatment) with standard 12-month DAPT followed by 12-month aspirin monotherapy (reference treatment) in patients treated with a biolimus A9-eluting stent. The primary endpoint was a composite of all-cause death or new Q-wave myocardial infarction (MI) at 2 years. Results: Among the 15,845 patients included in this subgroup analysis, 2,498 patients (15.8%) underwent PCI for at least one bifurcation lesion. The incidence of the primary endpoint was similar between the bifurcation and nonbifurcation groups (4.7 vs. 4.0%, p =.083). The experimental treatment had no significant effect on the primary endpoint according to the presence/absence of a bifurcation lesion (bifurcation: hazard ratio [HR]: 0.74, 95% confidence interval [CI]: 0.51–1.07; nonbifurcation: HR: 0.90, 95% CI: 0.76–1.07, p for interaction =.343), but was associated with significant reduction in definite or probable stent thrombosis (p for interaction =.022) and significant excess of stroke (p for interaction =.018) when compared with the reference treatment. Conclusions: After PCI for bifurcation lesions using 1-month of DAPT followed by ticagrelor monotherapy for 23 months did not demonstrate explicit benefit regarding all-cause death or new Q-wave MI as in the overall trial.

Original languageEnglish
Pages (from-to)100-111
Number of pages12
JournalCatheterization and Cardiovascular Interventions
Volume96
Issue number1
DOIs
Publication statusPublished - Jul 1 2020

Keywords

  • antiplatelet treatment
  • bifurcation lesion
  • drug-eluting stents
  • Percutaneous coronary intervention

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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