Efficacy and Safety of Ticagrelor Monotherapy in Patients Undergoing Multivessel PCI

Kuniaki Takahashi, Patrick W. Serruys*, Ply Chichareon, Chun Chin Chang, Mariusz Tomaniak, Rodrigo Modolo, Norihiro Kogame, Michael Magro, Saqib Chowdhary, Ingo Eitel, Robert Zweiker, Paul Ong, Michael Mundt Ottesen, Jan G.P. Tijssen, Joanna J. Wykrzykowska, Robbert J. de Winter, Scot Garg, Hans Peter Stoll, Christian Hamm, Philippe Gabriel StegYoshinobu Onuma, Marco Valgimigli, Pascal Vranckx, Didier Carrie, Stephan Windecker

*Corresponding author for this work
9 Citations (Scopus)


Background: Data on optimal antiplatelet treatment regimens in patients who undergo multivessel percutaneous coronary intervention (PCI) are sparse. Objectives: This post hoc study investigated the impact of an experimental strategy (1-month dual antiplatelet therapy [DAPT] followed by 23-month ticagrelor monotherapy) versus a reference regimen (12-month DAPT followed by 12-month aspirin monotherapy) according to multivessel PCI. Methods: The GLOBAL LEADERS trial is a prospective, multicenter, open-label, randomized controlled trial, allocating all-comer patients in a 1:1 ratio to either the experimental strategy or the reference regimen. The primary endpoint was the composite of all-cause death or new Q-wave myocardial infarction at 2 years. The secondary safety endpoint was Bleeding Academic Research Consortium type 3 or 5 bleeding. Results: Among the overall study population (n=15,845), 3,576 patients (22.4%) having multivessel PCI experienced a significantly higher risk of ischemic and bleeding events at 2 years, compared to those having single-vessel PCI. There was an interaction between the experimental strategy and multivessel PCI on the primary endpoint (hazard ratio: 0.62; 95% confidence interval: 0.44 to 0.88; pinteraction = 0.031). This difference was largely driven by a lower risk of all-cause mortality. In contrast, the risk of Bleeding Academic Research Consortium type 3 or 5 bleeding was statistically similar between the 2 regimens (hazard ratio: 0.92; 95% confidence interval: 0.61 to 1.39; pinteraction = 0.754). Conclusions: Long-term ticagrelor monotherapy following 1-month DAPT can favorably balance ischemic and bleeding risks in patients with multivessel PCI. These findings should be interpreted as hypothesis-generating and need to be replicated in future dedicated randomized trials. (GLOBAL LEADERS: A Clinical Study Comparing Two Forms of Anti-platelet Therapy After Stent Implantation; NCT01813435).

Original languageEnglish
JournalJournal of the American College of Cardiology
Issue number16
Pages (from-to)2015-2027
Number of pages13
Publication statusPublished - 22.10.2019

Research Areas and Centers

  • Centers: Cardiological Center Luebeck (UHZL)

DFG Research Classification Scheme

  • 205-12 Cardiology, Angiology


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