LB-9
Repeated coronary revascularization in high-risk patients treated with ticagrelor monotherapy after PCI: Insights from the randomized TWILIGHT trial
Presenter
Usman Baber, M.D., The University Of Oklahoma Health Sciences Center, Oklahoma City, OK
Usman Baber, M.D.1, Alessandro Spirito, MD2, Samantha Sartori, PhD2, David J. Cohen, M.D., FSCAI3, Adnan Kastrati, MD4, C. Michael Gibson, M.D., MSCAI5, David J. Moliterno, M.D.6, Birgit Vogel, MD2, Javier Escaned, M.D., Ph.D.7, Gennaro Sardella, M.D.8, Timothy Collier9, Dominick J. Angiolillo, M.D., FSCAI10, Stuart Pocock, Ph.D.9, George D. Dangas, M.D., Ph.D., MSCAI11 and Roxana Mehran, M.D., MSCAI2, (1)The University Of Oklahoma Health Sciences Center, Oklahoma City, OK, (2)Icahn School of Medicine at Mount Sinai, New York, NY, (3)St. Francis Hospital, New York, NY, (4)Deutsches Herzzentrum München, Munich, Bavaria, Germany, (5)Beth Israel Deaconess Medical Center, Natick, MA, (6)University of Kentucky College of Medicine - Lexington, Lexington, KY, (7)Hospital Clínico San Carlos, Madrid, Spain, (8)Policlinico Umberto I, Roma, Italy, (9)London School of Hygiene and Tropical Medicine, London, United Kingdom, (10)UF Health Jacksonville, Jacksonville, FL, (11)Mount Sinai Hospital, New York, NY
Keywords: Acute Coronary Syndromes (ACS), Coronary, Pharmacotherapy and Stable Ischemic Heart Disease (SIHD)
Background
Repeat revascularization after percutaneous coronary intervention (PCI) remains a major concern, even though its impact on mortality is limited. The effect of ticagrelor monotherapy vs. standard dual antiplatelet therapy (DAPT) on this outcome is unclear. We aim to assess the impact of ticagrelor monotherapy vs. DAPT on repeat revascularization after PCI.
Methods
In the TWILIGHT trial, high-risk patients who were event-free and adherent to a ticagrelor-based DAPT for 3 months after PCI were randomized to ticagrelor plus aspirin or ticagrelor plus placebo for 12 additional months. In this post-hoc analysis, the primary endpoint was repeat revascularization due to recurrent or persistent symptomatic myocardial ischemia. Secondary endpoints included target lesion revascularization (TLR), target vessel revascularization (TVR) and major adverse cardiac and cerebrovascular events (MACCE) and net adverse clinical events (NACE) (
Figure). All endpoints were adjudicated and assessed at 12 months after randomization in the per-protocol population.
Results
Among 6,759 patients, ticagrelor monotherapy and ticagrelor plus aspirin were associated with a similar risk of repeat revascularization (7.1% vs 6.7%, HR 1.07, 95% CI 0.89-1.29), TLR, TVR and MACCE (
Figure 1), while NACE was lower with ticagrelor monotherapy.
Conclusions
In high-risk patients undergoing PCI, ticagrelor monotherapy after 3 months of ticagrelor plus aspirin was associated with similar rates of recurrent coronary revascularization and MACCE and a lower risk of NACE compared with continued DAPT.
