Ticagrelor monotherapy beyond one month after PCI in ACS or stable CAD in elderly patients: a pre-specified analysis of the GLOBAL LEADERS trial
| العنوان: | Ticagrelor monotherapy beyond one month after PCI in ACS or stable CAD in elderly patients: a pre-specified analysis of the GLOBAL LEADERS trial |
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| المؤلفون: | Kuniaki Takahashi, Clemens Steinwender, Mariusz Tomaniak, Usman Baber, Paweł Buszman, Marcello Dominici, Philippe Gabriel Steg, Janusz Prokopczuk, Stephan Windecker, Patrick W. Serruys, Yoshinobu Onuma, Peter Jüni, Richard Anderson, Marco Valgimigli, Rodrigo Modolo, Ply Chichareon, Chun Chin Chang, Tessa Rademaker-Havinga, Pascal Vranckx, Ernest Spitzer, Norihiro Kogame, Manel Sabaté, Krzysztof Zmudka, Christian W. Hamm, Tobias Geisler, Veselin Valkov, Robert-Jan van Geuns, Jan G.P. Tijssen |
| المساهمون: | Graduate School, ACS - Atherosclerosis & ischemic syndromes, ACS - Microcirculation, ACS - Heart failure & arrhythmias, Cardiology, University of Zurich, Serruys, Patrick W |
| المصدر: | EuroIntervention, 15(18), E1605-E1617. EuroPCR EuroIntervention, 15(18), e1605-e1614. EuroPCR |
| سنة النشر: | 2019 |
| مصطلحات موضوعية: | Stable angina, medicine.medical_specialty, Ticagrelor, 610 Medicine & health, Subgroup analysis, 030204 cardiovascular system & hematology, 11171 Cardiocentro Ticino, 2705 Cardiology and Cardiovascular Medicine, law.invention, Time, 03 medical and health sciences, 0302 clinical medicine, Percutaneous Coronary Intervention, Randomized controlled trial, law, Internal medicine, medicine, Clinical endpoint, Adjunctive pharmacotherapy, Humans, 030212 general & internal medicine, Myocardial infarction, Aged, Aged, 80 and over, Aspirin, ACS/NSTE-ACS, business.industry, Elderly (>75), Bleeding, Hazard ratio, medicine.disease, Treatment Outcome, Conventional PCI, Purinergic P2Y Receptor Antagonists, Drug Therapy, Combination, Cardiology and Cardiovascular Medicine, business, Platelet Aggregation Inhibitors, medicine.drug |
| الوصف: | AIMS: Antiplatelet treatment in the elderly post percutaneous coronary interventions (PCI) remains a complex issue. Here we report the results of the pre-specified subgroup analysis of the GLOBAL LEADERS trial evaluating the long-term safety and cardiovascular efficacy of ticagrelor monotherapy among patients categorised according to the pre-specified cut-off value of 75 years of age. METHODS AND RESULTS: This was a pre-specified analysis of the randomised GLOBAL LEADERS trial (n=15,991), comparing 23-month ticagrelor monotherapy (after one month of DAPT) with the reference treatment (12-month DAPT followed by 12 months of aspirin). Among elderly patients (>75 years; n=2,565), the primary endpoint (two-year all-cause mortality or new Q-wave core lab-adjudicated myocardial infarction [MI]) occurred in 7.2% and 9.4% of patients in the ticagrelor monotherapy and the reference group, respectively (hazard ratio [HR] 0.75, 95% confidence interval [CI]: 0.58-0.99, p=0.041; pint=0.23); BARC-defined bleeding type 3/5 occurred in 5.2% and 4.1%, respectively (HR 1.29, 95% CI: 0.89-1.86; p=0.180; pint=0.06). The elderly with stable CAD had a higher rate of BARC 3/5 type bleeding (HR 2.05, 95% CI: 1.18-3.55) with ticagrelor monotherapy versus the reference treatment (pint=0.02). Elderly patients had a lower rate of definite or probable stent thrombosis (ST) with ticagrelor monotherapy (0.4% vs 1.4%, p=0.015, pint=0.01), compared with the reference group. CONCLUSIONS: In this pre-specified, exploratory analysis of the overall neutral trial, there was no differential treatment effect of ticagrelor monotherapy (after one-month dual therapy with aspirin) found in elderly patients undergoing PCI with respect to the rate of the primary endpoint of all-cause death or new Q-wave MI. The lower rate of ST in the elderly with ticagrelor monotherapy is hypothesis-generating. ClinicalTrials.gov identifier: NCT01813435. |
| وصف الملف: | LEADERS_tria.pdf - application/pdf |
| تدمد: | 1969-6213 1774-024X |
| الوصول الحر: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::5f11ee7e8815567d17730f8929d64e36Test https://pubmed.ncbi.nlm.nih.gov/31845894Test |
| حقوق: | OPEN |
| رقم الانضمام: | edsair.doi.dedup.....5f11ee7e8815567d17730f8929d64e36 |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 19696213 1774024X |
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