Ticagrelor monotherapy tied to lower all-cause death in patients undergoing multivessel PCI

An experimental strategy of 1-month dual antiplatelet therapy (DAPT) followed by long-term ticagrelor monotherapy (23 months) shows a favourable balance of ischaemia and bleeding risks in patients who undergo multivessel percutaneous coronary intervention (PCI), according to a recent study.

“Data on optimal antiplatelet treatment regimens in patients who undergo multivessel PCI are sparse,” the authors said.

To address this problem, a prospective, multicentre, open-label, randomized controlled trial was conducted. The authors randomly assigned patients 1:1 to either the experimental strategy (1-month DAPT followed by 23-month ticagrelor) or the reference regimen (12-month DAPT followed by 12-month aspirin monotherapy).

The primary endpoint was the composite of all-cause death or new Q-wave myocardial infarction at 2 years, and the secondary endpoint was Bleeding Academic Research Consortium type 3 or 5 bleeding.

Of the 15,845 patients identified, 3,576 (22.4 percent) with multivessel PCI had a significantly higher risk of ischaemic and bleeding events at 2 years compared to those with single-vessel PCI.

An interaction was observed on the primary endpoint between the experimental strategy and multivessel PCI (hazard ratio [HR], 0.62, 95 percent CI, 0.44–0.88; p-interaction=0.031), with the difference primarily driven by a lower risk of all-cause death.

On the other hand, the two regimens demonstrated statistically similar risk of Bleeding Academic Research Consortium type 3 or 5 bleeding (HR, 0.92, 0.61–1.39; p-interaction=0.754).

“These findings should be interpreted as hypothesis-generating and need to be replicated in future dedicated randomized trials,” the authors said.