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

Publication ,  Journal Article
Valgimigli, M; Mehran, R; Franzone, A; da Costa, BR; Baber, U; Piccolo, R; McFadden, EP; Vranckx, P; Angiolillo, DJ; Leonardi, S; Cao, D ...
Published in: JACC Cardiovasc Interv
February 22, 2021

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.

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Published In

JACC Cardiovasc Interv

DOI

EISSN

1876-7605

Publication Date

February 22, 2021

Volume

14

Issue

4

Start / End Page

444 / 456

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Ticagrelor
  • Platelet Aggregation Inhibitors
  • Percutaneous Coronary Intervention
  • Humans
  • Dual Anti-Platelet Therapy
  • Drug Therapy, Combination
  • Cardiovascular System & Hematology
  • 3201 Cardiovascular medicine and haematology
  • 1102 Cardiorespiratory Medicine and Haematology
 

Citation

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Valgimigli, M., Mehran, R., Franzone, A., da Costa, B. R., Baber, U., Piccolo, R., … SIDNEY Collaboration, . (2021). Ticagrelor Monotherapy Versus Dual-Antiplatelet Therapy After PCI: An Individual Patient-Level Meta-Analysis. JACC Cardiovasc Interv, 14(4), 444–456. https://doi.org/10.1016/j.jcin.2020.11.046
Valgimigli, Marco, Roxana Mehran, Anna Franzone, Bruno R. da Costa, Usman Baber, Raffaele Piccolo, Eùgene P. McFadden, et al. “Ticagrelor Monotherapy Versus Dual-Antiplatelet Therapy After PCI: An Individual Patient-Level Meta-Analysis.JACC Cardiovasc Interv 14, no. 4 (February 22, 2021): 444–56. https://doi.org/10.1016/j.jcin.2020.11.046.
Valgimigli M, Mehran R, Franzone A, da Costa BR, Baber U, Piccolo R, et al. Ticagrelor Monotherapy Versus Dual-Antiplatelet Therapy After PCI: An Individual Patient-Level Meta-Analysis. JACC Cardiovasc Interv. 2021 Feb 22;14(4):444–56.
Valgimigli, Marco, et al. “Ticagrelor Monotherapy Versus Dual-Antiplatelet Therapy After PCI: An Individual Patient-Level Meta-Analysis.JACC Cardiovasc Interv, vol. 14, no. 4, Feb. 2021, pp. 444–56. Pubmed, doi:10.1016/j.jcin.2020.11.046.
Valgimigli M, Mehran R, Franzone A, da Costa BR, Baber U, Piccolo R, McFadden EP, Vranckx P, Angiolillo DJ, Leonardi S, Cao D, Dangas GD, Mehta SR, Serruys PW, Gibson CM, Steg GP, Sharma SK, Hamm C, Shlofmitz R, Liebetrau C, Briguori C, Janssens L, Huber K, Ferrario M, Kunadian V, Cohen DJ, Zurakowski A, Oldroyd KG, Yaling H, Dudek D, Sartori S, Kirkham B, Escaned J, Heg D, Windecker S, Pocock S, Jüni P, SIDNEY Collaboration. Ticagrelor Monotherapy Versus Dual-Antiplatelet Therapy After PCI: An Individual Patient-Level Meta-Analysis. JACC Cardiovasc Interv. 2021 Feb 22;14(4):444–456.
Journal cover image

Published In

JACC Cardiovasc Interv

DOI

EISSN

1876-7605

Publication Date

February 22, 2021

Volume

14

Issue

4

Start / End Page

444 / 456

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Ticagrelor
  • Platelet Aggregation Inhibitors
  • Percutaneous Coronary Intervention
  • Humans
  • Dual Anti-Platelet Therapy
  • Drug Therapy, Combination
  • Cardiovascular System & Hematology
  • 3201 Cardiovascular medicine and haematology
  • 1102 Cardiorespiratory Medicine and Haematology