SCAI 2023: Similar revascularisation rates seen with ticagrelor monotherapy and DAPT in TWILIGHT trial

Usman Baber

Ticagrelor monotherapy after three months of ticagrelor plus aspirin was associated with similar rates of recurrent coronary revascularisation, major adverse cardiac and cerebrovascular events (MACCE) and a lower risk of net adverse clinical events (NACE) compared with dual antiplatelet therapy (DAPT).

This is according to findings from the TWILIGHT trial, a randomised controlled trial of more than 7,000 patients, findings of which were presented at the Society for Cardiovascular Angiography & Interventions (SCAI) 2023 scientific sessions (18–20 May, Phoenix, USA).

Despite advances in percutaneous coronary intervention (PCI) techniques, devices and secondary prevention, repeat revascularisation remains a concern and is associated with increased morbidity, hospitalisation and healthcare costs, investigators stated.

In the TWILIGHT trial, high-risk patients who were event-free and adherent to a ticagrelor- based DAPT for three months after PCI were randomised to ticagrelor plus aspirin or ticagrelor plus placebo for 12 additional months.

The primary endpoint was repeat revascularisation due to recurrent or persistent symptomatic myocardial ischaemia. Secondary endpoints included target lesion revascularisation (TLR), target vessel revascularisation (TVR), MACCE and NACE. All endpoints were adjudicated and assessed at 12 months after randomisation in the per-protocol population.

Among 7,039 patients, ticagrelor monotherapy and ticagrelor plus aspirin were associated with a similar risk of repeat revascularisation (7.1% vs. 6.6%, hazard ratio [HR] 1.09, 95% confidence interval [CI] 0.90–1.30), TLR, TVR and MACCE, while NACE was lower with ticagrelor monotherapy. The results also showed that clinically-driven revascularisation was associated with an excess risk for subsequent death, myocardial infarction or stroke (aHR 2.92, 95% CI 1.82–4.67).

“In high-risk PCI patients, it is critical to lessen the occurrence of repeat revascularisation,” said Usman Baber (University of Oklahoma Health Sciences Center, Oklahoma City, USA), lead author of the study. “The findings presented today from the TWILIGHT trial provide a greater understanding of the impact of DAPT and ticagrelor monotherapy following PCI for the clinical community.”


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