Ticagrelor Monotherapy Versus Dual-Antiplatelet Therapy After PCI: An Individual Patient-Level Meta-Analysis.

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; ... (2021). Ticagrelor Monotherapy Versus Dual-Antiplatelet Therapy After PCI: An Individual Patient-Level Meta-Analysis. JACC. Cardiovascular Interventions, 14(4), pp. 444-456. Elsevier 10.1016/j.jcin.2020.11.046

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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.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology

UniBE Contributor:

Valgimigli, Marco, Windecker, Stephan

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1876-7605

Publisher:

Elsevier

Language:

English

Submitter:

Nadia Biscozzo

Date Deposited:

20 Jan 2022 15:12

Last Modified:

05 Dec 2022 15:59

Publisher DOI:

10.1016/j.jcin.2020.11.046

PubMed ID:

33602441

Uncontrolled Keywords:

DAPT P2Y(12) inhibitors aspirin meta-analysis ticagrelor

BORIS DOI:

10.48350/163221

URI:

https://boris.unibe.ch/id/eprint/163221

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