Impact of white blood cell count on clinical outcomes in patients treated with aspirin-free ticagrelor monotherapy after percutaneous coronary intervention: insights from the GLOBAL LEADERS trial.

Abstract

AIMS:

The aim of this study was to investigate the efficacy and safety of ticagrelor monotherapy in patients undergoing percutaneous coronary intervention (PCI) stratified according to the baseline white blood cell (WBC) count.

METHODS AND RESULTS:

This is a post hoc analysis of the GLOBAL LEADERS trial, a multi-centre, open-label, randomized all-comer trial in patients undergoing PCI, comparing the experimental strategy (23-month ticagrelor monotherapy following 1-month dual anti-platelet therapy [DAPT]) with the reference strategy (12-month aspirin monotherapy following 12-month DAPT). Patients were stratified into two WBC groups, either < or ≥median WBC count of 7.8 × 109 cells/L (lower or higher WBC group, respectively). The primary endpoint was a composite of all-cause mortality or new Q-wave myocardial infarction at 2 years. Of 14 576 patients included in the present study, 7212 patients (49.5%) were classified as the lower WBC group, who had a significantly lower risk of both ischaemic and bleeding outcomes at 2 years. At 2 years, the experimental strategy was associated with a significant lower incidence of the primary endpoint compared with the reference strategy in the lower WBC group [2.8% vs. 4.2%; hazard ratio (HR): 0.67; 95% confidence interval (CI): 0.52-0.86] but not in the higher WBC group (4.8% vs. 4.7%; HR: 1.01; 95% CI: 0.82-1.25; Pinteraction=0.013). There were no significant differences in the risks of Bleeding Academic Research Consortium type 3 or 5 bleeding between two anti-platelet strategies regardless of the WBC groups.

CONCLUSION:

Increased WBC counts, which may reflect degree of inflammation, at the time of index procedure may attenuate the anti-ischaemic benefits of ticagrelor monotherapy observed in patients with lower WBC counts.

• Authors: Masafumi Ono, Mariusz Tomaniak, Wolfgang Koenig, Ramzi Khamis, Ranil de Silva, Ply Chichareon, Hideyuki Kawashima, Hironori Hara, Chao Gao, Rutao Wang, Kurt Huber, Mathias Vrolix, Pawel Jasionowicz, Joanna J Wykrzykowska, Jan J Piek, Peter Jüni, Christian Hamm, Philippe Gabriel Steg, Stephan Windecker, Yoshinobu Onuma, Robert F Storey, Patrick W Serruys
• Journal: European heart journal. Cardiovascular pharmacotherapy (Eur Heart J Cardiovasc Pharmacother) Vol. 8 Issue 1 Pg. 39-47 (01 05 2022) ISSN: 2055-6845 [Electronic] England
• PMID: 32956446 (Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
• Copyright: Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2020. For permissions, please email: [email protected].

Chemical References

• Platelet Aggregation Inhibitors
• Ticagrelor
• Aspirin

Topics

• Aspirin (adverse effects)
• Humans
• Leukocyte Count
• Percutaneous Coronary Intervention (adverse effects)
• Platelet Aggregation Inhibitors (adverse effects)
• Ticagrelor (adverse effects)
• Treatment Outcome