Ticagrelor With or Without Aspirin After Complex Percutaneous Coronary Intervention

被引：130

作者：

Dangas, George ^{[1
]}

Baber, Usman ^{[1
]}

Sharma, Samin ^{[1
]}

Giustino, Gennaro ^{[1
]}

Mehta, Shamir ^{[2
,3
]}

Cohen, David J. ^{[4
]}

Angiolillo, Dominick J. ^{[5
]}

Sartori, Samantha ^{[1
]}

Chandiramani, Rishi ^{[1
]}

Briguori, Carlo ^{[6
]}

Dudek, Dariusz ^{[7
,8
]}

Escaned, Javier ^{[9
]}

Huber, Kurt ^{[10
,11
]}

Collier, Timothy ^{[12
]}

Kornowski, Ran ^{[13
]}

Kunadian, Vijay ^{[14
,15
]}

Kaul, Upendra ^{[16
]}

Oldroyd, Keith ^{[17
]}

Sardella, Gennaro ^{[18
]}

Shlofmitz, Richard ^{[19
]}

Witzenbichler, Bernhard ^{[20
]}

Han Ya-Ling ^{[21
]}

Pocock, Stuart ^{[12
]}

Gibson, C. Michael ^{[22
]}

Mehran, Roxana ^{[1
]}

机构：

[1] Icahn Sch Med Mt Sinai, Zena & Michael A Wiener Cardiovasc Inst, New York, NY 10029 USA

[2] McMaster Univ, Populat Hlth Res Inst, Hamilton, ON, Canada

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

[4] Univ Missouri, Kansas City, MO 64110 USA

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

[6] Mediterranea Cardioctr, Naples, Italy

[7] Jagiellonian Univ Med Coll, Inst Cardiol, Krakow, Poland

[8] GVM Care & Res, Maria Cecilia Hosp, Cotignola, RA, Italy

[9] Univ Complutense Madrid, Hosp Clin San Carlos IDISSC, Madrid, Spain

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

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

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

[13] Rabin Med Ctr, Cardiol Dept, Petah Tiqwa, Israel

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

[15] Newcastle Upon Tyne Hosp NHS Fdn Trust, Freeman Hosp, Newcastle Upon Tyne, Tyne & Wear, England

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

[17] Golden Jubilee Natl Hosp, West Scotland Heart & Lung Ctr, Glasgow, Lanark, Scotland

[18] Sapienza Univ Rome, Policlin Umberto I, Dept Cardiol, Rome, Italy

[19] St Francis Hosp, Roslyn, NY USA

[20] Helios Amper Klinikum, Dept Cardiol & Pneumol, Dachau, Germany

[21] Gen Hosp Shenyang Mil Reg, Dept Cardiol, Shenyang, Liaoning, Peoples R China

[22] Harvard Med Sch, Beth Israel Deaconess Med Ctr, Div Cardiovasc Med, Boston, MA 02115 USA

来源：

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY | 2020年 / 75卷 / 19期

关键词：

aspirin; bleeding; complex PCI; dual antiplatelet therapy; ticagrelor monotherapy; DUAL ANTIPLATELET THERAPY; DRUG-ELUTING STENTS; ACUTE MYOCARDIAL-INFARCTION; RISK PATIENTS; REVASCULARIZATION; IMPACT; DES; DISEASE; EVENTS; PCI;

D O I：

10.1016/j.jacc.2020.03.011

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

BACKGROUND Whether a regimen of ticagrelor monotherapy attenuates bleeding complications without increasing ischemic risk in patients undergoing complex percutaneous coronary intervention (PCI) is unknown. OBJECTIVES The purpose of this study was to evaluate the effect of ticagrelor monotherapy versus ticagrelor plus aspirin in patients undergoing complex PCI from the randomized, double-blind, placebo-controlled TWILIGHT (Ticagrelor with Aspirin or Alone in High-Risk Patients after Coronary Intervention) trial. METHODS In the TWILIGHT trial, after 3 months of ticagrelor plus aspirin, event-free and adherent patients remained on ticagrelor and were randomly assigned to receive aspirin or placebo for 1 year. Complex PCI was defined as any of the following: 3 vessels treated, $3 lesions treated, total stent length >60 mm, bifurcation with 2 stents implanted, atherectomy device use, left main PCI, surgical bypass graft or chronic total occlusion as target lesions. Bleeding and ischemic endpoints were evaluated at 1 year after randomization. RESULTS Among 7,119 patients randomized in the main trial, complex PCI was performed in 2,342 patients. Compared to ticagrelor plus aspirin, ticagrelor plus placebo resulted in significantly lower rates of Bleeding Academic Research Consortium (BARC) type 2, 3, or 5 bleeding (4.2% vs. 7.7%; hazard ratio [HR]: 0.54; 95% confidence interval [CI]: 0.38 to 0.76). BARC type 3 or 5 bleeding was also significantly reduced (1.1% vs. 2.6%; HR: 0.41; 95% CI: 0.21 to 0.80). There were no significant between-group differences in death, myocardial infarction, or stroke (3.8% vs. 4.9%; HR: 0.77; 95% CI: 0.52 to 1.15), nor in stent thrombosis. CONCLUSIONS Among patients undergoing complex PCI who initially completed 3 months of ticagrelor plus aspirin, continuation of ticagrelor monotherapy was associated with lower incidence of bleeding without increasing the risk of ischemic events compared to continuing ticagrelor plus aspirin. (Ticagrelor With Aspirin or Alone in High-Risk Patients After Coronary Intervention [TWILIGHT]; NCT02270242) (J Am Coll Cardiol 2020;75:2414-24) (c) 2020 by the American College of Cardiology Foundation.

引用

页码：2414 / 2424

页数：11

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