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

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

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 and Department of Cardiology, Cork University Hospital, Cork, Ireland
3. University of Pavia and Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
4. Department of Cardiology and Critical Care Medicine, Hartcentrum Hasselt, Jessa Ziekenhuis, Belgium
5. Department of Cardiology, Imperial College of London, UK
6. Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany and German Center for Cardiovascular Research (DZHK); Partner site RheinMain, Frankfurt am Main, Germany
7. Université de Paris and AP-HP, Paris, France
8. Institute of Social and Preventive Medicine and Clinical Trials Unit, University of Bern, Bern, Switzerland
9. Applied Health Research Centre, Li Ka Shing Knowledge Institute of St Michael's Hospital, Department of Medicine, University of Toronto, Ontario, Canada
10. Department of Cardiology, Inselspital, University of Bern, Switzerland
11. Jessa Hospital, Department of Cardiology, Hasselt, Belgium Christoph Liebetrau, MD, Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany and German Center for Cardiovascular Research (DZHK), partner site RheinMain, Frankfurt am
12. Imelda Hospital, Bonheiden, Belgium
13. Center of Cardiovascular Research and Development, American Heart of Poland, Katowice, Poland
14. Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands
15. S. Maria University-Hospital, Terni, Italy
16. 3rd Medical Department, Cardiology, Wilhelminen hospital, and Sigmund Freud University Medical School, Vienna, Austria
17. OLVG Amsterdam, Amsterdam, the Netherlands
18. Center for Cardiovascular Research and Development, American Heart of Poland, Katowice, Poland
19. Azienda Toscana Usl Sudest Arezzo Italy
20. Cardiology Unit Sant'Anna Hospital, Ferrara, Italy
21. Jagiellonian University Medical College, The John Paul II Hospital, Krakow, Poland
22. Department of cardiology, Centre Hospitalier Universitaire de Charleroi, Charleroi, Belgium
23. Ziekenhuis Oost Limburg, Genk, Belgium
24. Acibadem City Clinic Cardiovascular Center, Sofia, Bulgaria
25. East Lancashire Hospitals NHS Trust, Blackburn, UK
26. Contilia Heart and Vascular Centre, Stadtspital Triemli Zürich, Switzerland
27. PAKS Kozle, Poland
28. , Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany and German Center for Cardiovascular Research (DZHK), partner site RheinMain, Frankfurt am Main, Germany
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Aims:  To investigate the effect of ticagrelor monotherapy after 1-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 of3,840 ACS and 3,745 SIHD (stable ischemic heart disease) patients were included. At 2-year, rates of co-primary efficacy endpoint, composite of death, myocardial infarction, stroke or urgent target-vessel revascularization, were 7.94% in the experimental and 9.68% in the control group (RR, 0.82, 95% CI, 0.66-1.01) among ACS 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, composite of both co-primary study endpoints, favored the experimental treatment among ACS patients only.

Conclusions:  Ticagrelor monotherapy after 1-month DAPT provided consistent treatment effects on ischemic endpoints in patients with or without ACS but only the former experienced a net clinical benefit. Trial registration  ClinicalTrials.gov number NCT03231059

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