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Ticagrelor Monotherapy After PCI in High-Risk Patients With Prior MI: A Prespecified TWILIGHT Substudy.

Publication ,  Journal Article
Chiarito, M; Baber, U; Cao, D; Sharma, SK; Dangas, G; Angiolillo, DJ; Briguori, C; Cohen, DJ; Dudek, D; Džavík, V; Escaned, J; Gil, R ...
Published in: JACC Cardiovasc Interv
February 14, 2022

OBJECTIVES: The aim of this study was to evaluate if patients with prior myocardial infarction (MI) could benefit from ticagrelor monotherapy in terms of bleeding reduction without any compromise in ischemic event prevention. BACKGROUND: Patients with history of MI who undergo percutaneous coronary intervention (PCI) remain at risk for recurrent ischemic events. The optimal antithrombotic strategy for this cohort remains debated. METHODS: In this prespecified analysis of the randomized TWILIGHT (Ticagrelor With Aspirin or Alone in High-Risk Patients after Coronary Intervention) trial, the authors evaluated the impact of history of MI on treatment effect of ticagrelor monotherapy versus ticagrelor plus aspirin in patients undergoing PCI with drug-eluting stent with at least 1 clinical and 1 angiographic high-risk feature and free from adverse events at 3 months after index PCI. The primary endpoint was Bleeding Academic Research Consortium type 2, 3, or 5 bleeding, and the key secondary endpoint was the composite of all-cause death, MI, or stroke, both at 12 months after randomization. RESULTS: A total of 1,937 patients (29.7%) with and 4,595 patients (70.3%) without prior MI were randomized to ticagrelor and placebo or ticagrelor and aspirin. At 1 year after randomization, patients with prior MI experienced higher rates of death, MI, or stroke (5.7% vs 3.2%; P < 0.001) but similar BARC types 2 to 5 bleeding (5.0% vs 5.5%; P = 0.677) compared with patients without prior MI. Ticagrelor monotherapy consistently reduced the risk for the primary bleeding outcome in patients with (3.4% vs 6.7%; HR: 0.50; 95% CI: 0.33-0.76) and without (4.2% vs 7.0%; HR: 0.58; 95% CI: 0.45-0.76; Pinteraction = 0.54) prior MI. Rates of the key secondary ischemic outcome were not significantly different between treatment groups irrespective of history of MI (prior MI, 6.0% vs 5.5% [HR: 1.09; 95% CI: 0.75-1.58]; no prior MI, 3.1% vs 3.3% [HR: 0.92; 95% CI: 0.67-1.28]; Pinteraction = 0.52). CONCLUSIONS: Ticagrelor monotherapy is associated with significantly lower risk for bleeding events compared with ticagrelor plus aspirin, without any compromise in ischemic prevention, among high-risk patients with history of MI undergoing PCI. (Ticagrelor With Aspirin or Alone in High-Risk Patients After Coronary Intervention [TWILIGHT]; NCT02270242).

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Published In

JACC Cardiovasc Interv

DOI

EISSN

1876-7605

Publication Date

February 14, 2022

Volume

15

Issue

3

Start / End Page

282 / 293

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Ticagrelor
  • Platelet Aggregation Inhibitors
  • Percutaneous Coronary Intervention
  • Myocardial Infarction
  • Humans
  • Drug-Eluting Stents
  • Drug Therapy, Combination
  • Cardiovascular System & Hematology
  • 3201 Cardiovascular medicine and haematology
 

Citation

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Chiarito, M., Baber, U., Cao, D., Sharma, S. K., Dangas, G., Angiolillo, D. J., … Mehran, R. (2022). Ticagrelor Monotherapy After PCI in High-Risk Patients With Prior MI: A Prespecified TWILIGHT Substudy. JACC Cardiovasc Interv, 15(3), 282–293. https://doi.org/10.1016/j.jcin.2021.11.005
Chiarito, Mauro, Usman Baber, Davide Cao, Samin K. Sharma, George Dangas, Dominick J. Angiolillo, Carlo Briguori, et al. “Ticagrelor Monotherapy After PCI in High-Risk Patients With Prior MI: A Prespecified TWILIGHT Substudy.JACC Cardiovasc Interv 15, no. 3 (February 14, 2022): 282–93. https://doi.org/10.1016/j.jcin.2021.11.005.
Chiarito M, Baber U, Cao D, Sharma SK, Dangas G, Angiolillo DJ, et al. Ticagrelor Monotherapy After PCI in High-Risk Patients With Prior MI: A Prespecified TWILIGHT Substudy. JACC Cardiovasc Interv. 2022 Feb 14;15(3):282–93.
Chiarito, Mauro, et al. “Ticagrelor Monotherapy After PCI in High-Risk Patients With Prior MI: A Prespecified TWILIGHT Substudy.JACC Cardiovasc Interv, vol. 15, no. 3, Feb. 2022, pp. 282–93. Pubmed, doi:10.1016/j.jcin.2021.11.005.
Chiarito M, Baber U, Cao D, Sharma SK, Dangas G, Angiolillo DJ, Briguori C, Cohen DJ, Dudek D, Džavík V, Escaned J, Gil R, Hamm CW, Henry T, Huber K, Kastrati A, Kaul U, Kornowski R, Krucoff M, Kunadian V, Mehta SR, Moliterno D, Ohman EM, Oldroyd K, Sardella G, Zhongjie Z, Sartori S, Stefanini G, Shlofmitz R, Steg PG, Weisz G, Witzenbichler B, Han Y-L, Pocock S, Gibson CM, Mehran R. Ticagrelor Monotherapy After PCI in High-Risk Patients With Prior MI: A Prespecified TWILIGHT Substudy. JACC Cardiovasc Interv. 2022 Feb 14;15(3):282–293.
Journal cover image

Published In

JACC Cardiovasc Interv

DOI

EISSN

1876-7605

Publication Date

February 14, 2022

Volume

15

Issue

3

Start / End Page

282 / 293

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Ticagrelor
  • Platelet Aggregation Inhibitors
  • Percutaneous Coronary Intervention
  • Myocardial Infarction
  • Humans
  • Drug-Eluting Stents
  • Drug Therapy, Combination
  • Cardiovascular System & Hematology
  • 3201 Cardiovascular medicine and haematology