The Official Journal of EuroPCR and the European Association of Percutaneous Coronary Interventions (EAPCI)

Coronary interventions

Ticagrelor alone or conventional dual antiplatelet therapy in patients with stable or acute coronary syndromes

EuroIntervention 2020;16:627-633. DOI: 10.4244/EIJ-D-20-00145

1. Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy; 2. Cardialysis Core Laboratories and Clinical Trial Management, Rotterdam, the Netherlands; 3. Department of Cardiology, Cork University Hospital, Cork, Ireland; 4. University of Pavia and Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy; 5. Department of Cardiology and Critical Care Medicine, Hartcentrum Hasselt, Jessa Ziekenhuis, Hasselt, Belgium; 6. Department of Cardiology, Imperial College London, London, United Kingdom; 7. Department of Cardiology, National University of Ireland, Galway, Ireland; 8. German Center for Cardiovascular Research (DZHK), partner site RheinMain, Frankfurt am Main, and Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany; 9. Université de Paris and AP-HP, Paris, France; 10. Institute of Social and Preventive Medicine and Clinical Trials Unit, University of Bern, Bern, Switzerland; 11. Applied Health Research Centre, Li Ka Shing Knowledge Institute of St Michael’s Hospital, Department of Medicine, University of Toronto, Ontario, Canada; 12. Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland

Aims: The aim of this study was to investigate the effect of ticagrelor monotherapy after one-month dual antiplatelet therapy (DAPT) or conventional DAPT in patients with or without acute coronary syndrome (ACS) in the GLOBAL LEADERS Adjudication Sub-StudY (GLASSY).

Methods and results: Risk estimates were expressed as rate ratios (RR) with 95% confidence intervals (CI). A total of 3,840 ACS and 3,745 stable ischaemic heart disease (SIHD) patients were included. At two years, rates of the co-primary efficacy endpoint, a composite of death, myocardial infarction, stroke or urgent target vessel revascularisation, were 7.94% in the experimental and 9.68% in the control group (RR 0.82, 95% CI: 0.66-1.01) among ACS patients and 6.31% in the experimental and 7.14% in the control group (RR 0.89, 95% CI: 0.69-1.13) among SIHD patients (pint=0.63). Trends for lower and higher risk of BARC 3 or 5 bleeding with the experimental strategy in ACS (2.27% vs 3.00%, RR 0.76, 95% CI: 0.51-1.12) and SIHD (2.70% vs 1.96%, RR 1.39, 95% CI: 0.91-2.12) patients, respectively, were observed with significant interaction testing (pint=0.039). A net clinical benefit endpoint, the composite of both co-primary study endpoints, favoured the experimental treatment among ACS patients only.

Conclusions: Ticagrelor monotherapy after one-month DAPT provided consistent treatment effects on ischaemic endpoints in patients with or without ACS but only the former experienced a net clinical benefit. ClinicalTrials.gov identifier: NCT03231059

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