{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,12]],"date-time":"2025-10-12T02:34:42Z","timestamp":1760236482673,"version":"build-2065373602"},"reference-count":25,"publisher":"MDPI AG","issue":"23","license":[{"start":{"date-parts":[[2021,11,24]],"date-time":"2021-11-24T00:00:00Z","timestamp":1637712000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>(1) Shorter-duration dual antiplatelet therapy (DAPT) followed by single antiplatelet therapy has been shown to significantly reduce bleeding events while preserving anti-ischemic effects in patients undergoing conventional percutaneous coronary interventions (PCI). Whether this strategy is also safe and effective in complex PCI remains elusive; (2) A systematic search of randomized controlled trials comparing a short course of ticagrelor-based DAPT versus standard DAPT in patients undergoing complex PCI was performed; (3) Of 10,689 studies screened, 3 were identified for a total of 4176 participants on ticagrelor monotherapy after a short course of ticagrelor-based DAPT, and 4209 on standard DAPT. The pooled analysis revealed no difference in the outcomes of major bleeding, myocardial infarction, definite or probable stent thrombosis and ischemic stroke. A significant reduction in the risk of cardiovascular death (incidence rate ratio (IRR) 0.52; 95% CI 0.28\u20130.96; p = 0.04), all-cause death (IRR 0.65; 95% CI 0.49\u20130.86; p = 0.003), and any bleeding events (IRR 0.62; 95% CI 0.47\u20130.81; p &lt; 0.001) was seen in the shorter DAPT group; (4) Among patients undergoing complex PCI, ticagrelor monotherapy after a short course of ticagrelor-based DAPT significantly reduced bleeding risk without increasing ischemic risk. More data are needed to definitively explain mortality benefits.<\/jats:p>","DOI":"10.3390\/jcm10235506","type":"journal-article","created":{"date-parts":[[2021,12,1]],"date-time":"2021-12-01T01:43:22Z","timestamp":1638323002000},"page":"5506","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Walking the Line with Ticagrelor: Meta-Analysis Comparing the Safety and Efficacy of Ticagrelor Monotherapy after a Short Course of Ticagrelor-Based Dual Antiplatelet Therapy versus Standard Therapy in Complex Percutaneous Coronary Intervention"],"prefix":"10.3390","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7830-4341","authenticated-orcid":false,"given":"Francesco","family":"Condello","sequence":"first","affiliation":[{"name":"Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20090 Milan, Italy"},{"name":"IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1096-962X","authenticated-orcid":false,"given":"Matteo","family":"Sturla","sequence":"additional","affiliation":[{"name":"Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20090 Milan, Italy"},{"name":"IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4305-3172","authenticated-orcid":false,"given":"Riccardo","family":"Terzi","sequence":"additional","affiliation":[{"name":"Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20090 Milan, Italy"},{"name":"IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9166-3031","authenticated-orcid":false,"given":"Alberto","family":"Polimeni","sequence":"additional","affiliation":[{"name":"Center for Cardiovascular Diseases, Department of Medical and Surgical Sciences, Division of Cardiology and Research, \u201cMagna Graecia\u201d University, Viale Europa Snc, 88100 Catanzaro, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3558-6967","authenticated-orcid":false,"given":"Giulio G.","family":"Stefanini","sequence":"additional","affiliation":[{"name":"Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20090 Milan, Italy"},{"name":"IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2021,11,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1093\/eurheartj\/ehx419","article-title":"2017 ESC Focused Update on Dual Antiplatelet Therapy in Coronary Artery Disease Developed in Collaboration with EACTS","volume":"39","author":"Valgimigli","year":"2018","journal-title":"Eur. Heart J."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1851","DOI":"10.1016\/j.jacc.2016.07.760","article-title":"Efficacy and Safety of Dual Antiplatelet Therapy after Complex PCI","volume":"68","author":"Giustino","year":"2016","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Brinza, C., Burlacu, A., Tinica, G., Covic, A., and Macovei, L. (2021). A Systematic Review on Bleeding Risk Scores\u2019 Accuracy after Percutaneous Coronary Interventions in Acute and Elective Settings. Healthcare, 9.","DOI":"10.3390\/healthcare9020148"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"444","DOI":"10.1016\/j.jcin.2020.11.046","article-title":"Ticagrelor Monotherapy Versus Dual-Antiplatelet Therapy after PCI","volume":"14","author":"Valgimigli","year":"2021","journal-title":"JACC Cardiovasc. Interv."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"308","DOI":"10.1093\/eurheartj\/ehaa739","article-title":"Short Dual Antiplatelet Therapy Followed by P2Y12 Inhibitor Monotherapy vs. Prolonged Dual Antiplatelet Therapy after Percutaneous Coronary Intervention with Second-Generation Drug-Eluting Stents: A Systematic Review and Meta-Analysis of Randomized Clinic","volume":"42","author":"Giacoppo","year":"2021","journal-title":"Eur. Heart J."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1016\/j.ijcard.2018.03.103","article-title":"Impact of Percutaneous Coronary Intervention Extent, Complexity and Platelet Reactivity on Outcomes after Drug-Eluting Stent Implantation","volume":"268","author":"Giustino","year":"2018","journal-title":"Int. J. Cardiol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"741","DOI":"10.1016\/j.jacc.2018.11.048","article-title":"Dual Antiplatelet Therapy Duration Based on Ischemic and Bleeding Risks after Coronary Stenting","volume":"73","author":"Costa","year":"2019","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1007\/s00392-018-1316-1","article-title":"Complex PCI Procedures: Challenges for the Interventional Cardiologist","volume":"107","author":"Werner","year":"2018","journal-title":"Clin. Res. Cardiol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"l4898","DOI":"10.1136\/bmj.l4898","article-title":"RoB 2: A Revised Tool for Assessing Risk of Bias in Randomised Trials","volume":"2019","author":"Sterne","year":"2019","journal-title":"BMJ"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"629","DOI":"10.1136\/bmj.315.7109.629","article-title":"Bias in Meta-Analysis Detected by a Simple, Graphical Test","volume":"315","author":"Egger","year":"1997","journal-title":"BMJ"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"2595","DOI":"10.1093\/eurheartj\/ehz453","article-title":"Impact of Long-Term Ticagrelor Monotherapy Following 1-Month Dual Antiplatelet Therapy in Patients Who Underwent Complex Percutaneous Coronary Intervention: Insights from the Global Leaders Trial","volume":"40","author":"Serruys","year":"2019","journal-title":"Eur. Heart J."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"2414","DOI":"10.1016\/j.jacc.2020.03.011","article-title":"Ticagrelor with or without Aspirin after Complex PCI","volume":"75","author":"Dangas","year":"2020","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"e010812","DOI":"10.1161\/CIRCINTERVENTIONS.121.010812","article-title":"Ticagrelor Monotherapy Versus Ticagrelor with Aspirin in Acute Coronary Syndrome Patients with a High Risk of Ischemic Events","volume":"14","author":"Lee","year":"2021","journal-title":"Circ. Cardiovasc. Interv."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"550","DOI":"10.4244\/EIJ-D-20-01197","article-title":"Mortality after Bleeding versus Myocardial Infarction in Coronary Artery Disease: A Systematic Review and Meta-Analysis","volume":"17","author":"Piccolo","year":"2021","journal-title":"EuroIntervention"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"e016495","DOI":"10.1161\/JAHA.120.016495","article-title":"Pharmacodynamic Comparison of Ticagrelor Monotherapy Versus Ticagrelor and Aspirin in Patients After Percutaneous Coronary Intervention: The TEMPLATE (Ticagrelor Monotherapy and Platelet Reactivity) Randomized Controlled Trial","volume":"9","author":"Johnson","year":"2020","journal-title":"J. Am. Heart Assoc."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e010384","DOI":"10.1161\/CIRCINTERVENTIONS.120.010384","article-title":"Very Short Dual Antiplatelet Therapy after Drug-Eluting Stent Implantation in Patients Who Underwent Complex Percutaneous Coronary Intervention: Insight from the STOPDAPT-2 Trial","volume":"14","author":"Yamamoto","year":"2021","journal-title":"Circ. Cardiovasc. Interv."},{"key":"ref_17","unstructured":"Watanabe, H. (2021, January 27\u201330). STOPDAPT-2 ACS: One-Month Dual Antiplatelet Therapy Followed by Clopidogrel Monotherapy in Acute Coronary Syn-Drome. Proceedings of the ESC Congress 2021-The Digital Experience, London, UK."},{"key":"ref_18","first-page":"1","article-title":"Uncertainties about Platelet Function and Genetic Testing for Guiding Dual Antiplatelet Therapy in Percutaneous Coronary Intervention","volume":"2021","author":"Condello","year":"2021","journal-title":"J. Thromb. Thrombolysis"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"2577","DOI":"10.1161\/CIRCULATIONAHA.109.912550","article-title":"Randomized Double-Blind Assessment of the ONSET and OFFSET of the Antiplatelet Effects of Ticagrelor Versus Clopidogrel in Patients with Stable Coronary Artery Disease","volume":"120","author":"Gurbel","year":"2009","journal-title":"Circulation"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1289","DOI":"10.1093\/eurheartj\/ehaa575","article-title":"2020 ESC Guidelines for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation","volume":"42","author":"Collet","year":"2021","journal-title":"Eur. Heart J."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"835","DOI":"10.1016\/S0140-6736(18)31714-8","article-title":"Radial versus Femoral Access and Bivalirudin versus Unfractionated Heparin in Invasively Managed Patients with Acute Coronary Syndrome (MATRIX): Final 1-Year Results of a Multicentre, Randomised Controlled Trial","volume":"392","author":"Valgimigli","year":"2018","journal-title":"Lancet"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1293","DOI":"10.1016\/j.jcin.2021.03.041","article-title":"Randomized Comparison between Radial and Femoral Large-Bore Access for Complex Percutaneous Coronary Intervention","volume":"14","author":"Meijers","year":"2021","journal-title":"JACC Cardiovasc. Interv."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"3281","DOI":"10.1093\/eurheartj\/ehy285","article-title":"Clinical Use of Intracoronary Imaging. Part 1: Guidance and Optimization of Coronary Interventions. An Expert Consensus Document of the European Association of Percutaneous Cardiovascular Interventions","volume":"39","author":"Mintz","year":"2018","journal-title":"Eur. Heart J."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"e14","DOI":"10.15420\/usc.2020.33","article-title":"Platelet Function Testing and Genotyping for Tailoring Treatment in Complex PCI Patients","volume":"15","author":"Moulias","year":"2021","journal-title":"US Cardiol. Rev."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"e014676","DOI":"10.1161\/JAHA.119.014676","article-title":"Clinical Implications of \u201cTailored\u201d Antiplatelet Therapy in Patients with Chronic Total Occlusion","volume":"9","author":"Marcucci","year":"2020","journal-title":"J. Am. Heart Assoc."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/10\/23\/5506\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T07:35:22Z","timestamp":1760168122000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/10\/23\/5506"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,11,24]]},"references-count":25,"journal-issue":{"issue":"23","published-online":{"date-parts":[[2021,12]]}},"alternative-id":["jcm10235506"],"URL":"https:\/\/doi.org\/10.3390\/jcm10235506","relation":{},"ISSN":["2077-0383"],"issn-type":[{"type":"electronic","value":"2077-0383"}],"subject":[],"published":{"date-parts":[[2021,11,24]]}}}