TY - JOUR
T1 - Safety and efficacy of ticagrelor monotherapy according to drug-eluting stent type
T2 - the TWILIGHT-STENT study
AU - Dangas, George
AU - Baber, Usman
AU - Sharma, Samin
AU - Giustino, Gennaro
AU - Sartori, Samantha
AU - Nicolas, Johny
AU - Goel, Ridhima
AU - Mehta, Shamir
AU - Cohen, David
AU - Angiolillo, Dominick J.
AU - Zhang, Zhongjie
AU - Camaj, Anton
AU - Cao, Davide
AU - Briguori, Carlo
AU - Dudek, Dariusz
AU - Escaned, Javier
AU - Huber, Kurt
AU - Collier, Timothy
AU - Kornowski, Ran
AU - Kunadian, Vijay
AU - Moliterno, David J.
AU - Magnus Ohman, E.
AU - Weisz, Giora
AU - Gil, Robert
AU - Krucoff, Mitchell W.
AU - Kaul, Upendra
AU - Oldroyd, Keith G.
AU - Sardella, Gennaro
AU - Shlofmitz, Richard
AU - Witzenbichler, Bernhard
AU - Kastrati, Adnan
AU - Han, Ya Ling
AU - Steg, Philippe Gabriel
AU - Pocock, Stuart
AU - Gibson, C. Michael
AU - Mehran, Roxana
N1 - Publisher Copyright:
© Europa Digital & Publishing 2022. All rights reserved.
PY - 2022/3
Y1 - 2022/3
N2 - Background: In the TWILIGHT trial, ticagrelor monotherapy after a short course of dual antiplatelet therapy (DAPT) was shown to be a safe bleeding avoidance strategy in high-risk patients undergoing percutaneous coronary intervention (PCI) with drug-eluting stents (DES). Aims: The aim of this study was to evaluate the effects of ticagrelor monotherapy after three-month DAPT in patients undergoing PCI, according to DES type. Methods: In the current sub-analysis from TWILIGHT, patients were stratified into three groups based on DES type: durable polymer everolimus-eluting stents (DP-EES), durable polymer zotarolimus-eluting stents (DP-ZES), and biodegradable polymer DES (BP-DES). Bleeding and ischaemic outcomes were assessed at one year after randomisation. Results: Out of 5,769 patients, 3,014 (52.2%) had DP-EES, 1,350 (23.4%) had DP-ZES and 1,405 (24.4%) had BP-DES. Compared with ticagrelor plus aspirin, ticagrelor monotherapy had significantly lower BARC type 2, 3 or 5 bleeding compared with DAPT; DP-EES (3.8% vs 6.7%; HR 0.56, 95% CI: 0.41-0.78), DP-ZES (4.6% vs 6.9%; HR 0.66, 95% CI: 0.42-1.04) and BP-DES (4.2% vs 7.9%; HR 0.52, 95% CI: 0.33-0.81; pinteraction=0.76). Ticagrelor monotherapy resulted in similar rates of death, MI, or stroke: DP-EES (4.2% vs 4.3%; HR 0.97; 95% CI: 0.68-1.37); DP-ZES (4.1% vs 3.1%; HR 1.32; 95% CI: 0.75-2.33); BP-DES (3.9% vs 4.2%; HR 0.92; 95% CI: 0.54-1.55; pinteraction=0.60). In both unadjusted and covariateadjusted analyses, DES type was not associated with any differences in ischaemic or bleeding complications. Conclusions: As compared with ticagrelor plus aspirin, ticagrelor monotherapy after a short DAPT duration lowered bleeding complications without increasing the ischaemic risk, irrespective of DES type. We observed no significant differences among DES types.
AB - Background: In the TWILIGHT trial, ticagrelor monotherapy after a short course of dual antiplatelet therapy (DAPT) was shown to be a safe bleeding avoidance strategy in high-risk patients undergoing percutaneous coronary intervention (PCI) with drug-eluting stents (DES). Aims: The aim of this study was to evaluate the effects of ticagrelor monotherapy after three-month DAPT in patients undergoing PCI, according to DES type. Methods: In the current sub-analysis from TWILIGHT, patients were stratified into three groups based on DES type: durable polymer everolimus-eluting stents (DP-EES), durable polymer zotarolimus-eluting stents (DP-ZES), and biodegradable polymer DES (BP-DES). Bleeding and ischaemic outcomes were assessed at one year after randomisation. Results: Out of 5,769 patients, 3,014 (52.2%) had DP-EES, 1,350 (23.4%) had DP-ZES and 1,405 (24.4%) had BP-DES. Compared with ticagrelor plus aspirin, ticagrelor monotherapy had significantly lower BARC type 2, 3 or 5 bleeding compared with DAPT; DP-EES (3.8% vs 6.7%; HR 0.56, 95% CI: 0.41-0.78), DP-ZES (4.6% vs 6.9%; HR 0.66, 95% CI: 0.42-1.04) and BP-DES (4.2% vs 7.9%; HR 0.52, 95% CI: 0.33-0.81; pinteraction=0.76). Ticagrelor monotherapy resulted in similar rates of death, MI, or stroke: DP-EES (4.2% vs 4.3%; HR 0.97; 95% CI: 0.68-1.37); DP-ZES (4.1% vs 3.1%; HR 1.32; 95% CI: 0.75-2.33); BP-DES (3.9% vs 4.2%; HR 0.92; 95% CI: 0.54-1.55; pinteraction=0.60). In both unadjusted and covariateadjusted analyses, DES type was not associated with any differences in ischaemic or bleeding complications. Conclusions: As compared with ticagrelor plus aspirin, ticagrelor monotherapy after a short DAPT duration lowered bleeding complications without increasing the ischaemic risk, irrespective of DES type. We observed no significant differences among DES types.
KW - adjunctive pharmacotherapy
KW - bleeding
KW - clinical trials
KW - drug-eluting stent
UR - http://www.scopus.com/inward/record.url?scp=85125519080&partnerID=8YFLogxK
U2 - 10.4244/EIJ-D-21-00721
DO - 10.4244/EIJ-D-21-00721
M3 - Article
C2 - 34881696
AN - SCOPUS:85125519080
SN - 1774-024X
VL - 17
SP - 130
EP - 1339
JO - EuroIntervention
JF - EuroIntervention
IS - 16
ER -