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Safety and efficacy of ticagrelor monotherapy according to drug-eluting stent type: the TWILIGHT-STENT study

Authors :
Dangas, George
Baber, Usman
Sharma, Samin
Giustino, Gennaro
Sartori, Samantha
Nicolas, Johny
Goel, Ridhima
Mehta, Shamir
Cohen, David J.
Angiolillo, Dominick J.
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
Source :
EuroIntervention
Publication Year :
2022
Publisher :
Europa Digital & Publishing, 2022.

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; p(interaction)=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; p(interaction)=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.

Details

ISSN :
1774024X
Volume :
17
Database :
OpenAIRE
Journal :
EuroIntervention
Accession number :
edsair.doi.dedup.....4a44673d9ec0da01fde576aec961fa55
Full Text :
https://doi.org/10.4244/eij-d-21-00721