TY - JOUR
T1 - Ticagrelor Monotherapy Versus Dual-Antiplatelet Therapy After PCI
T2 - An Individual Patient-Level Meta-Analysis
AU - Valgimigli, Marco
AU - Mehran, Roxana
AU - Franzone, Anna
AU - da Costa, Bruno R.
AU - Baber, Usman
AU - Piccolo, Raffaele
AU - McFadden, Eùgene P.
AU - Vranckx, Pascal
AU - Angiolillo, Dominick J.
AU - Leonardi, Sergio
AU - Cao, Davide
AU - Dangas, George D.
AU - Mehta, Shamir R.
AU - Serruys, Patrick W.
AU - Gibson, C. Michael
AU - Steg, Gabriel P.
AU - Sharma, Samin K.
AU - Hamm, Christian
AU - Shlofmitz, Richard
AU - Liebetrau, Christoph
AU - Briguori, Carlo
AU - Janssens, Luc
AU - Huber, Kurt
AU - Ferrario, Maurizio
AU - Kunadian, Vijay
AU - Cohen, David J.
AU - Zurakowski, Aleksander
AU - Oldroyd, Keith G.
AU - Yaling, Han
AU - Dudek, Dariuz
AU - Sartori, Samantha
AU - Kirkham, Brian
AU - Escaned, Javier
AU - Heg, Dik
AU - Windecker, Stephan
AU - Pocock, Stuart
AU - Jüni, Peter
AU - Mehta, Shamir
AU - Gibson, Michael C.
AU - Kastrati, Adnan
AU - Krucoff, Mitchel
AU - Ohman, Magnus E.
AU - Gurbel, Paul
AU - Henry, Timothy D.
AU - Moliterno, David
AU - Heg, Dierik
AU - McFadden, Eugene
AU - Marx, Steven O.
AU - Darrow, Bruce
AU - Corvaja, Nicola
N1 - Publisher Copyright:
© 2021 American College of Cardiology Foundation
PY - 2021/2/22
Y1 - 2021/2/22
N2 - 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.
AB - 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.
KW - DAPT
KW - P2Y inhibitors
KW - aspirin
KW - meta-analysis
KW - ticagrelor
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U2 - 10.1016/j.jcin.2020.11.046
DO - 10.1016/j.jcin.2020.11.046
M3 - Article
C2 - 33602441
AN - SCOPUS:85100435785
SN - 1936-8798
VL - 14
SP - 444
EP - 456
JO - JACC: Cardiovascular Interventions
JF - JACC: Cardiovascular Interventions
IS - 4
ER -