Ticagrelor alone or conventional dual antiplatelet therapy in patients with stable or acute coronary syndromes.

AIMS To investigate the effect of ticagrelor monotherapy after 1-month dual antiplatelet therapy (DAPT) or conventional DAPT in patients with or without acute coronary syndrome (ACS) in the GLOBAL LEADERS Adjudication Sub-Study (GLASSY). METHODS AND RESULTS Risk estimates were expressed as rate ratios (RR) with 95% confidence intervals (CI). A total of3,840 ACS and 3,745 SIHD (stable ischemic heart disease) patients were included. At 2-year, rates of co-primary efficacy endpoint, composite of death, myocardial infarction, stroke or urgent target-vessel revascularization, were 7.94% in the experimental and 9.68% in the control group (RR, 0.82, 95% CI, 0.66-1.01) among ACS and 6.31% in the experimental and 7.14% in the control group (RR, 0.89, 95% CI, 0.69-1.13) among SIHD patients (Pint= 0.63). Trends for lower and higher risk of BARC 3 or 5 bleeding with the experimental strategy in ACS (2.27% vs. 3.00%, RR, 0.76, 95% CI, 0.51-1.12) and SIHD (2.70% vs. 1.96%, RR, 1.39, 95% CI, 0.91-2.12) patients, respectively, were observed with significant interaction testing (Pint=0.039). A net clinical benefit endpoint, composite of both co-primary study endpoints, favored the experimental treatment among ACS patients only. CONCLUSIONS Ticagrelor monotherapy after 1-month DAPT provided consistent treatment effects on ischemic endpoints in patients with or without ACS but only the former experienced a net clinical benefit. Trial registration ClinicalTrials.gov number NCT03231059.