- NEWS . 24 Feb 2020
Experimental treatment with ticagrelor monotherapy benefits non-obese ACS patients
A subgroup analysis of a large, multicentre, randomized controlled trial has demonstrated a beneficial effect of ticagrelor monotherapy in non-obese acute coronary syndrome (ACS) patients.
The GLOBAL LEADERS trial, a prospective, multicentre, open-label, randomized controlled trial comprising 15,968 patients undergoing PCI, was set up to compare the experimental strategy (23-month ticagrelor monotherapy after 1-month dual antiplatelet therapy [DAPT]) with a reference regimen (12-month aspirin monotherapy after 12-month DAPT).
The prespecified subgroup analysis stratified patients by baseline body mass index (BMI) with a threshold of 27 kg/m2. Of these, 6,973 (43.7%) patients with a BMI <27 kg/m2 had a higher risk of all-cause mortality at 2 years than those with BMI ≥27 kg/m2 (adjusted hazard ratio [HR] 1.24, 95% confidence interval [CI] 1.02–1.49). At 2 years, the rates of the primary endpoint (all-cause mortality or new Q-wave myocardial infarction) were similar between treatment strategies in either BMI group (pinteraction=0.51). However, in ACS the experimental strategy was associated with significant reduction of the primary endpoint compared with the reference strategy in patients with BMI <27 kg/m2 (HR, 0.69; 95% CI, 0.51–0.94), but not in the ones with BMI ≥27 kg/m2 (pinteraction=0.047). In chronic coronary syndrome, no between-group difference was seen in the efficacy and safety of the two antiplatelet strategies.
In conclusion, BMI did not influence the treatment effect seen with ticagrelor monotherapy; however, a beneficial effect of ticagrelor monotherapy was seen in non-obese ACS patients (BMI <27 kg/m2).
Ono M, et al. The association of body mass index with long-term clinical outcomes after ticagrelor monotherapy following abbreviated dual antiplatelet therapy in patients undergoing percutaneous coronary intervention: a prespecified sub-analysis of the GLOBAL LEADERS Trial. Clin Res Cardiol 2020. doi: 10.1007/s00392-020-01604-1. [Epub ahead of print]