Association of Pulse Pressure With Clinical Outcomes in Patients Under Different Antiplatelet Strategies After Percutaneous Coronary Intervention: Analysis of GLOBAL LEADERS.

de Faria, Ana Paula; Modolo, Rodrigo; Chichareon, Ply; Chang, Chun-Chin; Kogame, Norihiro; Tomaniak, Mariusz; Takahashi, Kuniaki; Rademaker-Havinga, Tessa; Wykrzykowska, Joanna; de Winter, Rob J; Ferreira, Rui C; Sousa, Amanda; Lemos, Pedro A; Garg, Scot; Hamm, Christian; Juni, Peter; Vranckx, Pascal; Valgimigli, Marco; Windecker, Stephan; Onuma, Yoshinobu; ... (2020). Association of Pulse Pressure With Clinical Outcomes in Patients Under Different Antiplatelet Strategies After Percutaneous Coronary Intervention: Analysis of GLOBAL LEADERS. Canadian journal of cardiology, 36(5), pp. 747-755. Canadian Cardiology Publications 10.1016/j.cjca.2019.10.015

Text Association of Pulse Pressure With Clinical Outcomes in Patients under differend Antiplatelet Stretegies after Percutaneous coronary Intervention.pdf - Published Version Restricted to registered users only Available under License BORIS Standard License. Download (1MB)

BACKGROUND

We evaluated the association of pulse pressure (PP) and different antiplatelet regimes with clinical and safety outcomes in an all-comers percutaneous coronary intervention (PCI) population.

METHODS

In this analysis of GLOBAL LEADERS (n = 15,936) we compared the experimental therapy of 23 months of ticagrelor after 1 month of dual-antiplatelet therapy (DAPT) vs standard DAPT for 12 months followed by aspirin monotherapy in subjects who underwent PCI and were divided into 2 groups according to the median PP (60 mm Hg). The primary end point (all-cause death or new Q-wave myocardial infarction) and the composite end points: patient-oriented composite end points (POCE), Bleeding Academic Research Consortium (BARC) 3 or 5, and net adverse clinical events (NACE) were evaluated.

RESULTS

At 2 years, subjects in the high-PP group (n = 7971) had similar rates of the primary end point (4.3% vs 3.9%; P = 0.058), POCE (14.9% vs 12.7%; P = 0.051), and BARC 3 or 5 (2.5% vs 1.7%; P = 0.355) and higher rates of NACE (16.4% vs 13.7%; P = 0.037) compared with the low-PP group (n = 7965). Among patients with PP < 60 mm Hg, the primary end point (3.4% vs 4.4%, adjusted hazard ratio [aHR] 0.77, 95% confidence interval [CI] 0.61-0.96), POCE (11.8% vs 13.5%, aHR 0.86, 95% CI 0.76-0.98), NACE (12.8% vs 14.7%, aHR 0.85, 95% CI 0.76-0.96), and BARC 3 or 5 (1.4% vs 2.1%, aHR 0.69, 95% CI 0.49-0.97) were lower with ticagrelor monotherapy compared with DAPT. The only significant interaction was for BARC 3 or 5 (P = 0.008).

CONCLUSIONS

After contemporary PCI, subjects with high PP levels experienced high rates of NACE at 2 years. In those with low PP, ticagrelor monotherapy led to a lower risk of bleeding events compared with standard DAPT.

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