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Lookup NU author(s): Professor Vijay KunadianORCiD
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BACKGROUND: Short dual antiplatelet therapy (DAPT) followed by ticagrelor monotherapy may be a valuable therapeutic option for patients with chronic coronary syndrome (CCS) and high ischaemic risk (HIR) undergoing percutaneous coronary intervention (PCI). AIMS: We aimed to compare ticagrelor monotherapy with ticagrelor-based DAPT in CCS patients with and without HIR undergoing PCI. METHODS: The present analysis included the CCS cohort of the TWILIGHT trial, which randomised PCI patients to ticagrelor alone or in combination with aspirin for 12 months after 3 months of ticagrelor-based DAPT. Patients were stratified into HIR and non-HIR based on the 2019 European Society of Cardiology (ESC) CCS guidelines definition. Outcomes of interest were major adverse cardiac and cerebrovascular events (MACCE), a composite of death, myocardial infarction or stroke, and Bleeding Academic Research Consortium (BARC) Type 2-5 bleeding at 1 year. RESULTS: Of the 2,503 CCS patients who underwent randomisation, the ESC definition classified 1,264 (50.5%) as HIR and 1,239 (49.5%) as non-HIR. HIR patients displayed a higher risk of MACCE (3.9% vs 2.3%; p=0.015) and similar rates of BARC Type 2-5 bleeding (5.1% vs 5.7%; p=0.455) as compared to non-HIR patients. Ticagrelor monotherapy and ticagrelor-based DAPT were associated with similar risks of MACCE (HIR: 4.0% vs 3.8%, hazard ratio [HR] 1.06, 95% confidence interval [CI]: 0.60-1.85; non-HIR: 2.1% vs 2.6%, HR 0.80, 95% CI: 0.38-1.66, pinteraction=0.553) and bleeding (HIR: 4.7% vs 5.7%, HR 0.82, 95% CI: 0.50-1.33; non-HIR: 4.9% vs 6.7%, HR 0.71, 95% CI: 0.44-1.14; pinteraction=0.684) in both the HIR and non-HIR groups. CONCLUSIONS: In a post hoc analysis of the TWILIGHT trial that included CCS patients undergoing PCI, ticagrelor monotherapy after 3 months of DAPT appeared to be safe and was not associated with increased risks of ischaemic or bleeding events, regardless of baseline HIR status, compared with standard ticagrelor-based DAPT. These findings suggest the potential to expand guideline recommendations for ticagrelor monotherapy in CCS.
Author(s): Gitto M, Baber U, Sartori S, Vogel B, Angiolillo DJ, Briguori C, Cohen DJ, Collier T, Dudek D, Oliva A, Escaned J, Feng Y, Gibson CM, Han Y-L, Di Muro FM, Shlofmitz RA, Huber K, Steg PG, Sharma S, Sardella G, Kastrati A, Kaul U, Kornowski R, Kunadian V, Stefanini GG, Mehta SR, Dangas G, Mehran R
Publication type: Article
Publication status: Published
Journal: EuroIntervention
Year: 2025
Volume: 21
Issue: 10
Pages: 550-559
Online publication date: 16/05/2025
Acceptance date: 02/04/2018
ISSN (print): 1774-024X
ISSN (electronic): 1969-6213
Publisher: Europa Group
URL: https://doi.org/10.4244/EIJ-D-24-00973
DOI: 10.4244/EIJ-D-24-00973
PubMed id: 40375766
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