Dyspnea-Related Ticagrelor Discontinuation After Percutaneous Coronary Intervention

被引：11

作者：

Angiolillo, Dominick J. ^{[1
]}

Cao, Davide ^{[2
,3
]}

Sartori, Samantha ^{[2
]}

Baber, Usman ^{[4
]}

Dangas, George ^{[2
]}

Zhang, Zhongjie ^{[2
]}

Vogel, Birgit ^{[2
]}

Kunadian, Vijay ^{[5
,6
]}

Briguori, Carlo ^{[7
]}

Cohen, David J. ^{[8
,9
]}

Collier, Timothy ^{[10
]}

Dudek, Dariusz ^{[11
]}

Gibson, Michael ^{[12
]}

Gil, Robert ^{[13
]}

Huber, Kurt ^{[14
,15
]}

Kaul, Upendra ^{[16
]}

Kornowski, Ran ^{[17
]}

Krucoff, Mitchell W. ^{[18
]}

Ielasi, Alfonso ^{[19
]}

Stefanini, Giulio G. ^{[3
,20
]}

Pivato, Carlo A. ^{[3
,20
]}

Mehta, Shamir ^{[21
]}

Moliterno, David J. ^{[22
]}

Ohman, E. Magnus ^{[18
]}

Escaned, Javier ^{[23
]}

Sardella, Gennaro ^{[24
]}

Sharma, Samin K. ^{[2
]}

Shlofmitz, Richard ^{[9
]}

Weisz, Giora ^{[25
]}

Witzenbichler, Bernhard ^{[26
]}

Steg, P. Gabriel ^{[27
,28
]}

Pocock, Stuart ^{[12
]}

Mehran, Roxana ^{[2
]}

机构：

[1] Univ Florida, Div Cardiol, Coll Med, Jacksonville, FL USA

[2] Icahn Sch Med Mt Sinai, Zena & Michael A Wiener Cardiovasc Inst, New York, NY USA

[3] Humanitas Univ, Dept Biomed Sci, Pieve Emanuele, MI, Italy

[4] Univ Oklahoma, Dept Cardiol, Hlth Sci Ctr, Oklahoma City, OK USA

[5] Newcastle Univ, Translat & Clin Res Inst, Fac Med Sci, Newcastle Upon Tyne, England

[6] Newcastle Upon Tyne Hosp NHS Fdn Trust, Freeman Hosp, Newcastle Upon Tyne, England

[7] Mediterranea Cardioctr, Naples, Italy

[8] Cardiovasc Res Fdn, New York, NY USA

[9] St Francis Hosp, Roslyn, NY USA

[10] London Sch Hyg & Trop Med, Dept Med Stat, London, England

[11] Jagiellonian Univ, Med Coll, Krakow, Poland

[12] Harvard Med Sch, Beth Israel Deaconess Med Ctr, Div Cardiovasc Med, Boston, MA USA

[13] Minist Interior & Adm, Cent Clin Hosp, Ctr Postgrad Med Educ, Warsaw, Poland

[14] Wilhelminen Hosp, Dept Med Cardiol & Intens Care Med 3, Vienna, Austria

[15] Sigmund Freud Univ, Med Fac, Vienna, Austria

[16] Batra Hosp & Med Res Ctr, New Delhi, India

[17] Rabin Med Ctr, Petah Tiqwa, Israel

[18] Duke Univ, Med Ctr, Duke Clin Res Inst, Durham, NC USA

[19] Ist Clin St Ambrogio, Milan, Italy

[20] IRCCS Humanitas Res Hosp, Milan, Italy

[21] Hamilton Hlth Sci, Hamilton, ON, Canada

[22] Univ Kentucky, Lexington, KY USA

[23] Univ Complutense Madrid, Hosp Clin San Carlos IDISCC, Madrid, Spain

[24] Policlin Umberto I Univ, Rome, Italy

[25] Columbia Univ, Med Ctr, NewYork Presbyterian Hosp, New York, NY USA

[26] Helios Amper Klinikum, Dachau, Germany

[27] Univ Paris, Paris, France

[28] Assistance Paris Hop Paris, Paris, France

来源：

JACC-CARDIOVASCULAR INTERVENTIONS | 2023年 / 16卷 / 20期

关键词：

antiplatelet therapy discontinuation; aspirin; dyspnea; PCI; ticagrelor monotherapy; SECONDARY PREVENTION; ADENOSINE; RISK; CLOPIDOGREL; TOLERABILITY; ASSOCIATION; PREDICTION; CONSENSUS; THERAPY; ASPIRIN;

D O I：

10.1016/j.jcin.2023.08.019

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

BACKGROUND Nearly 20% of patients on ticagrelor experience dyspnea, which may lead to treatment discontinuation in up to one-third of cases. OBJECTIVES The authors sought to evaluate the incidence, predictors, and outcomes of dyspnea-related ticagrelor discontinuation after percutaneous coronary intervention (PCI). METHODS In the TWILIGHT (Ticagrelor With Aspirin or Alone in High-Risk Patients After Coronary Intervention) trial, after 3 months of ticagrelor plus aspirin, patients were maintained on ticagrelor and randomized to aspirin or placebo for 1 year. The occurrence of dyspnea associated with ticagrelor discontinuation was evaluated among all patients enrolled in the trial. A landmark analysis was performed at 3 months after PCI, that is, the time of randomization. Predictors of dyspnea-related ticagrelor discontinuation were obtained from multivariable Cox regression with stepwise selection of candidate variables. RESULTS The incidence of dyspnea-related ticagrelor discontinuation was 6.4% and 9.1% at 3 and 15 months after PCI, respectively. Independent predictors included Asian race (lower risk), smoking, prior PCI, hypercholesterolemia, prior coronary artery bypass, peripheral artery disease, obesity, and older age. Among 179 patients who discontinued ticagrelor because of dyspnea after randomization, ticagrelor monotherapy was not associated with a higher risk of subsequent ischemic events (composite of all-cause death, myocardial infarction, or stroke) compared with ticagrelor plus aspirin (5.0% vs 7.1%; P 1/4 0.566). CONCLUSIONS In the TWILIGHT trial, dyspnea-related ticagrelor discontinuation occurred in almost 1 in 10 patients and tended to occur earlier rather than late after PCI. Several demographic and clinical conditions predicted its occurrence, and their assessment may help identify subjects at risk for therapy nonadherence. (J Am Coll Cardiol Intv 2023;16:2514-2524) (c) 2023 by the American College of Cardiology Foundation.

引用

页码：2514 / 2524

页数：11

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