Dangas, George; Baber, Usman; Sharma, Samin; Giustino, Gennaro; Sartori, Samantha; Nicolas, Johny; Goel, Ridhima; Mehta, Shamir; Cohen, David; Angiolillo, Dominick J; +26 more... Zhang, Zhongjie; Camaj, Anton; Cao, Davide; Briguori, Carlo; Dudek, Dariusz; Escaned, Javier; Huber, Kurt; Collier, Timothy; Kornowski, Ran; Kunadian, Vijay; Moliterno, David J; Ohman, E Magnus; Weisz, Giora; Gil, Robert; Krucoff, Mitchell W; Kaul, Upendra; Oldroyd, Keith G; Sardella, Gennaro; Shlofmitz, Richard; Witzenbichler, Bernhard; Kastrati, Adnan; Han, Ya-Ling; Steg, Philippe Gabriel; Pocock, Stuart; Gibson, C Michael; Mehran, Roxana; (2023) Safety and efficacy of ticagrelor monotherapy according to drug-eluting stent type: the TWILIGHT-STENT study. EUROINTERVENTION, 17 (16). pp. 1330-1339. ISSN 1774-024X DOI: https://doi.org/10.4244/EIJ-D-21-00721
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Abstract
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 covariate-adjusted 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.
Item Type | Article |
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Faculty and Department | Faculty of Epidemiology and Population Health > Dept of Medical Statistics |
Research Centre | Clinical Trials Unit |
PubMed ID | 34881696 |
Elements ID | 173005 |
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Filename: Dangas_etal_2022_Safety-and-Efficacy-of-Ticagrelor.pdf
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