Repeated coronary revascularization in high-risk patients treated with ticagrelor monotherapy after PCI: Insights from the randomized TWILIGHT trial | SCAI

Why is this study important?

  • Assesses the results of ticagrelor monotherapy at one year, after three months of initial DAPT (dual antiplatelet therapy) in high-risk PCI (percutaneous coronary intervention) patients

What question was this study supposed to answer?

  • Is ticagrelor monotherapy vs. DAPT sufficient to reduce repeat revascularization (the primary endpoint), with PCI or CABG (coronary artery bypass grafting) for recurrent or persistent symptomatic ischemia
  • Secondary endpoints were also reported

What did the study show?

  • Post hoc analysis of 6,759 patients in the TWILIGHT trial
  • High risk PCI patients were enrolled
  • Ticagrelor monotherapy with initial 3 month of DAPT (Aspirin and Ticagrelor) was associated with:
  • Similar rates of repeat revascularization (7.1% vs 6.7%, HR 1.07, 95% CI 0.89-1.29)-the primary end point
  • Secondary endpoints demonstrated similar rates of:
    • Major adverse cardiac and cerebrovascular events (MACCE)
    • Target lesion revascularization (TLR)
    • Target vessel revascularization (TVR)
  • A benefit was seen in:
  • Effective reduction of BARC, 2,3,5 bleeding
  • Net adverse cardiac events (NACE)

Conclusion:

In high-risk PCI patients, Ticagrelor monotherapy after three months of initial DAPT, demonstrates safety without increased risk of repeat revascularization at 12 months.

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