Is Ticagrelor Monotherapy Superior to Antiplatelet Therapy in High-Risk PCI Patients?

In high-risk patients undergoing percutaneous coronary intervention (PCI), ticagrelor monotherapy following three months of ticagrelor plus aspirin is correlated with similar rates of recurrent coronary revascularization compared with standard dual antiplatelet therapy (DAPT), according to a study presented at the Society for Cardiovascular Angiography & Interventions (SCAI) 2023 Scientific Sessions.

Repeat revascularization following PCI remains a high concern and carries increased morbidity. As such, Usman Barber, MD, and colleagues, assessed the impact of ticagrelor monotherapy versus DAPT on repeat revascularization following PCI.

In this trial, called TWILIGHT, 6,759 high-risk patients who were both event free and adherent to a ticagrelor-based DAPT over the duration of three months post-PCI were randomized to either ticagrelor plus aspirin or ticagrelor plus placebo for 12 additional months. The key endpoint of interest was defined as repeat revascularization due to recurrent or persistent symptomatic myocardial ischemia. Secondary outcomes were included target lesion revascularization (TLR), target vessel revascularization (TVR) and major adverse cardiac and cerebrovascular events (MACCE) and net adverse clinical events (NACE).

According to the results, ticagrelor monotherapy and ticagrelor plus aspirin were linked with a similar risk of repeat revascularization (7.1% vs 6.7%, HR 1.07, 95% CI 0.89-1.29), TLR, TVR and MACCE compared with standard therapy, while NACE was lower with ticagrelor monotherapy.

“In high-risk PCI patients, it’s critical to lessen the occurrence of repeat revascularization,” said Dr. Baber, Associate Professor of Medicine at the University of Oklahoma Health Sciences Center, and lead author of the study via a press release. “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.”

Source: Baber U, Spirito A,  Sartori S, et al. Repeated coronary revascularization in high-risk patients treated with ticagrelor
monotherapy after PCI: Insights from the randomized TWILIGHT trial. Abstract #24764. Published for the Society for Cardiovascular Angiography & Interventions (SCAI) 2023 Scientific Sessions; May 18-20, 2023, Phoenix, AZ.