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

Text Ticagrelor_Monotherapy_Versus_Dual-Antiplatelet_Therapy.pdf - Published Version Restricted to registered users only Available under License Publisher holds Copyright. Download (1MB)

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.

Interest & Impact

Downloads

1 since deposited on 20 Jan 2022
0 in the past 12 months

Citations

5 Citations in Web of Science ®
6 Citations in Scopus

Search

in Google Scholar™

Services

Actions (login required)

Edit item

Actions (login required)

Edit item