{"id":"32b6e130b406","type":"article","url":"https://hartvaat.nl/2019/08/14/langetermijn-ticagrelor-monotherapie-na-1-maand-dapt-bij-complexe-pci-global-lea/","title":"Langetermijn ticagrelor monotherapie na 1 maand DAPT bij complexe PCI: GLOBAL LEADERS","title_en":"Impact of long-term ticagrelor monotherapy following 1-month dual antiplatelet therapy in patients who underwent complex percutaneous coronary intervention: insights from the Global Leaders trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"European heart journal","doi":"10.1093/eurheartj/ehz453","source_url":"https://doi.org/10.1093/eurheartj/ehz453","authors":["Patrick W Serruys","Kuniaki Takahashi","Ply Chichareon","Norihiro Kogame","Mariusz Tomaniak","Rodrigo Modolo","Chun Chin Chang","Hidenori Komiyama","Osama Soliman","Joanna J Wykrzykowska","Robbert J de Winter","Maurizio Ferrario","Marcello Dominici","Paweł Buszman","Leonardo Bolognese","Carlo Tumscitz","Edouard Benit","Hans-Peter Stoll","Christian Hamm","Philippe Gabriel Steg","Yoshinobu Onuma","Peter Jüni","Stephan Windecker","Pascal Vranckx","Antonio Colombo","Marco Valgimigli"],"significance":6,"published":"2019-08-14","source_date":"2019-08-14","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/stemi/"],"congress":"","summary_en":"This GLOBAL LEADERS subanalysis evaluated ticagrelor monotherapy after 1 month of DAPT in patients who underwent complex PCI, extending the de-escalation evidence to the highest-complexity interventional subgroup.","created":"2026-07-03T10:28:05Z","updated":"2026-07-03T13:27:17Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"GLOBAL LEADERS subanalyse naar de impact van ticagrelor monotherapie na 1 maand DAPT bij complexe PCI-patiënten.","abstract_original":"AIMS: To evaluate the impact of an experimental strategy [23-month ticagrelor monotherapy following 1-month dual antiplatelet therapy (DAPT)] vs. a reference regimen (12-month aspirin monotherapy following 12-month DAPT) after complex percutaneous coronary intervention (PCI). METHODS AND RESULTS: In the present post hoc analysis of the Global Leaders trial, the primary endpoint [composite of all-cause death or new Q-wave myocardial infarction (MI)] at 2 years was assessed in patients with complex PCI, which includes at least one of the following characteristics: multivessel PCI, ≥3 stents implanted, ≥3 lesions treated, bifurcation PCI with ≥2 stents, or total stent length >60 mm. In addition, patient-oriented composite endpoint (POCE) (composite of all-cause death, any stroke, any MI, or any revascularization) and net adverse clinical events (NACE) [composite of POCE or Bleeding Academic Research Consortium (BARC) Type 3 or 5 bleeding] were explored. Among 15 450 patients included in this analysis, 4570 who underwent complex PCI had a higher risk of ischaemic and bleeding events. In patients with complex PCI, the experimental strategy significantly reduced risks of the primary endpoint [hazard ratio (HR): 0.64, 95% confidence interval (CI): 0.48-0.85] and POCE (HR: 0.80, 95% CI: 0.69-0.93), but not in those with non-complex PCI (Pinteraction = 0.015 and 0.017, respectively). The risk of BARC Type 3 or 5 bleeding was comparable (HR: 0.97, 95% CI: 0.67-1.40), resulting in a significant risk reduction in NACE (HR: 0.80, 95% CI: 0.69-0.92; Pinteraction = 0.011). CONCLUSION: Ticagrelor monotherapy following 1-month DAPT could provide a net clinical benefit for patients with complex PCI. However, in view of the overall neutral results of the trial, these findings of a post hoc analysis should be considered as hypothesis generating."}