Key result
Ticagrelor monotherapy cuts clinically relevant bleeding ~44% vs. DAPT after PCI across stent types.
Why the study?
The safety and efficacy of ticagrelor monotherapy after short DAPT according to different drug-eluting stent types were not established.
Does ticagrelor monotherapy after 3-month DAPT reduce bleeding without increasing ischaemic risk compared to ticagrelor plus aspirin across different DES types in high-risk PCI patients?
RCT (n=5,769)
Double-blind
Randomized
Yes
Does ticagrelor monotherapy after 3-month DAPT reduce bleeding without increasing ischaemic risk compared to ticagrelor plus aspirin across different DES types in high-risk PCI patients?
Ticagrelor monotherapy after 3 months of DAPT safely reduces bleeding without increasing ischaemic risk across different types of drug-eluting stents in high-risk PCI patients.
Ticagrelor monotherapy reduces bleeding without ischemic harm across DES types; extends TWILIGHT findings but leaves stent-specific tailoring hypothesis-generating.
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. 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.
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Dangas et al. (2022) conducted an RCT in High-risk patients undergoing percutaneous coronary intervention (PCI) with drug-eluting stent (DES) (n=5,769). Ticagrelor monotherapy vs. Ticagrelor (90 mg twice daily) plus aspirin (81 to 100 mg daily) was evaluated on BARC type 2, 3 or 5 bleeding at 1 year after randomization (DP-EES subgroup) (HR 0.56, 95% CI 0.41-0.78). Ticagrelor monotherapy after 3 months of dual antiplatelet therapy reduced BARC type 2, 3, or 5 bleeding compared with ticagrelor plus aspirin across DP-EES (HR 0.56), DP-ZES (HR 0.66), and BP-DES (HR 0.52) stent types, without increasing ischemic risk.
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