In order to bring you the best possible user experience, this site uses Javascript. If you are seeing this message, it is likely that the Javascript option in your browser is disabled. For optimal viewing of this site, please ensure that Javascript is enabled for your browser.

The free consultation period for this content is over.

It is now only available year-round to ESC Professional Members, Fellows of the ESC, and Young combined Members

Potential benefit of ticagrelor monotherapy for patients with hypertension undergoing percutaneous coronary intervention: Insights from the Global Leaders trial

Session Poster Session 7

Speaker Rodrigo Modolo

Congress : ESC Congress 2019

  • Topic : coronary artery disease, acute coronary syndromes, acute cardiac care
  • Sub-topic : Coronary Artery Disease: Pharmacotherapy
  • Session type : Poster Session
  • FP Number : P6408

Authors : R Modolo (Amsterdam,NL), P Chichareon (Amsterdam,NL), AP De Faria (Campinas,BR), PG Steg (Paris,FR), C Hamm (Bad Nauheim,DE), P Vranckx (Hasselt,BE), M Valgimigli (Bern,CH), S Windecker (Bern,CH), Y Onuma (Rotterdam,NL), PW Serruys (London,GB)

R Modolo1 , P Chichareon1 , AP De Faria2 , PG Steg3 , C Hamm4 , P Vranckx5 , M Valgimigli6 , S Windecker6 , Y Onuma7 , PW Serruys8 , 1Academic Medical Center of Amsterdam, Department of Cardiology - Amsterdam - Netherlands (The) , 2State University of Campinas (UNICAMP), Department of Pharmacology - Campinas - Brazil , 3University Paris Diderot - Paris - France , 4Kerckhoff Heart and Thorax Center - Bad Nauheim - Germany , 5Virga Jesse Hospital - Hasselt - Belgium , 6Preventive Cardiology & Sports Medicine, Inselspital Bern - Bern - Switzerland , 7Erasmus Medical Center, Department of Cardiology - Rotterdam - Netherlands (The) , 8Imperial College London - London - United Kingdom of Great Britain & Northern Ireland ,



Background: Hypertension is one of the most frequent modifiable risk factors for coronary artery disease. Due to the increased risk of bleeding associated with it, hypertensive patients might benefit from an antiplatelet monotherapy following percutaneous coronary intervention.

Purpose: We sought to investigate the effect of 1-month DAPT followed by 23-month ticagrelor monotherapy (ticagrelor monotherapy) compared with the reference arm, 12-month DAPT followed by 12-month aspirin monotherapy (standard DAPT), on clinical outcomes in patients with hypertension undergoing PCI.

Methods: This is a post-hoc analysis of the prospective, multi-center, open-label, all-comers, randomized controlled trial Global Leaders, that tested ticagrelor monotherapy versus standard DAPT in patients receiving PCI with biolimus A9-eluting stent. Patients were stratified by the hypertension status. The primary endpoint for the present analysis was the patient oriented composite endpoint (POCE -  defined as composite of all-cause death, any stroke, any MI, or all revascularization) and safety endpoint of  BARC type 3 or 5 bleeding, both at 2 years. Event rates are presented as Kaplan-Meier estimates (%).

Results: In Global Leaders 15,991 patients were randomized, 23 (0.14%) requested complete deletion of their data from the database and 54 (0.34%) had no information on hypertension status. Of the 15,914 (99.52%) included in the analysis 11,715 were hypertensive.  In the non-hypertensive patients, comparing ticagrelor monotherapy with standard DAPT, no difference was found regarding POCE (12.17% vs. 12.13%, HR 1.004, 95% CI 0.843 to 1.195, p=0.965) nor bleeding (1.71% vs. 1.72%, HR 1.0, 95% CI 0.628 to 1.592, p=1.0, respectively). In hypertensive patients the experimental treatment of ticagrelor monotherapy resulted in less POCE (13.62% vs. 15.04%, HR 0.898, 95% CI 0.816 to 0.988, p=0.028, p for interaction=0.271) with similar bleeding (2.21% vs. 2.26%, HR 0.976, 95% CI 0.765 to 1.246, p=0.846), compared with the standard DAPT at 2 years.

Conclusion: In this sub-group analysis of Global Leaders, in patients with hypertension undergoing PCI the experimental treatment of 1-month DAPT followed by 23-month ticagrelor monotherapy may offer ischemic protection without increasing bleeding. The results must be interpreted cautiously as there was no interaction between treatment strategy and the status of hypertension. Thus, the present results are hypothesis generating.

Based on your interests

Members get more

Join now
  • 1ESC Professional Members – access all resources from ESC Congress and ESC Asia with APSC & AFC
  • 2ESC Association Members (Ivory, Silver, Gold) – access your Association’s congress resources
  • 3Under 40 or in training - with a Combined Membership, access resources from all congresses
Join now

Our sponsors

ESC 365 is supported by Bayer, Boehringer Ingelheim and Lilly Alliance, Bristol-Myers Squibb and Pfizer Alliance, Novartis Pharma AG and Vifor Pharma in the form of educational grants. The sponsors were not involved in the development of this platform and had no influence on its content.

logo esc

Our mission: To reduce the burden of cardiovascular disease

Who we are