Ticagrelor Monotherapy Versus Dual-Antiplatelet Therapy After PCI: An Individual Patient-Level Meta-Analysis.
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 None.
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