New insights from the TWILIGHT trial confirmed that ticagrelor monotherapy after three months of ticagrelor plus aspirin was related to related charges of recurrent coronary revascularization, main antagonistic cardiac and cerebrovascular occasions (MACCE) and a decrease threat of internet antagonistic scientific occasions (NACE) in contrast with duel antiplatelet remedy (DAPT). The outcomes from the randomized management trial of greater than 7,000 sufferers have been introduced immediately as late-breaking scientific analysis on the Society for Cardiovascular Angiography & Interventions (SCAI) 2023 Scientific Sessions.
Despite advances in percutaneous coronary intervention (PCI) methods, gadgets and secondary prevention, repeat revascularization stays a priority and is related to elevated morbidity, hospitalization and healthcare prices.
In the TWILIGHT trial, high-risk sufferers who have been event-free and adherent to a ticagrelor-based DAPT for 3 months after PCI have been randomized to ticagrelor plus aspirin or ticagrelor plus placebo for 12 extra months. The main endpoint was repeat revascularization on account of recurrent or persistent symptomatic myocardial ischemia. Secondary endpoints included goal lesion revascularization (TLR), goal vessel revascularization (TVR) and main antagonistic cardiac and cerebrovascular occasions (MACCE) and internet antagonistic scientific occasions (NACE). All endpoints have been adjudicated and assessed at 12 months after randomization within the per-protocol inhabitants.
Among 7,039 sufferers, ticagrelor monotherapy and ticagrelor plus aspirin have been related to an identical threat of repeat revascularization (7.1% vs 6.6%, HR 1.09, 95% CI 0.90-1.30), TLR, TVR and MACCE, whereas NACE was decrease with ticagrelor monotherapy. The outcomes additionally confirmed that clinically-driven revascularization was related to an extra threat for subsequent loss of life, myocardial infarction or stroke (aHR 2.92, 95% CI 1.82 – 4.67).
In high-risk PCI sufferers, it’s important to minimize the incidence of repeat revascularization. The findings introduced immediately from the TWILIGHT trial present a better understanding of the affect of DAPT and ticagrelor monotherapy following PCI for the scientific neighborhood.”
Usman Baber, M.D., Associate Professor of Medicine on the University of Oklahoma Health Sciences Center, and lead creator of the examine