Impact of Age on the Safety and Efficacy of Ticagrelor Monotherapy in Patients Undergoing PCI

• Published in: JACC. Cardiovascular interventions 2021-07, Vol.14 (13), p.1434-1446
• Main Authors: Angiolillo, Dominick J, Cao, Davide, Baber, Usman, Sartori, Samantha, Zhang, Zhongjie, Dangas, George, Mehta, Shamir, Briguori, Carlo, Cohen, David J, Collier, Timothy, Dudek, Dariusz, Escaned, Javier, Gibson, C Michael, Gil, Robert, Huber, Kurt, Kaul, Upendra, Kornowski, Ran, Krucoff, Mitchell W, Kunadian, Vijay, Moliterno, David J, Ohman, E Magnus, Oldroyd, Keith, Sardella, Gennaro, Sharma, Samin K, Shlofmitz, Richard, Weisz, Giora, Witzenbichler, Bernhard, Pocock, Stuart, Mehran, Roxana
• Format: Article
• Language: English
• Subjects: Age Factors; Aged; Aspirin - adverse effects; Drug Therapy, Combination; Humans; Percutaneous Coronary Intervention; Platelet Aggregation Inhibitors - adverse effects; Ticagrelor - adverse effects; Treatment Outcome
• ISSN: 1936-8798; 1876-7605
• DOI: 10.1016/j.jcin.2021.04.043

The aim of this study was to assess the impact of age on the safety and efficacy of ticagrelor monotherapy after percutaneous coronary intervention (PCI). As the risk for bleeding and ischemic complications after PCI increases with age, the authors conducted a pre-specified analysis of the TWILIGHT (Ticagrelor With Aspirin or Alone in High-Risk Patients After Coronary Intervention) trial to evaluate the possible benefits of ticagrelor monotherapy according to age. The TWILIGHT trial enrolled patients undergoing PCI with drug-eluting stents who fulfilled at least 1 clinical and 1 angiographic high-risk criterion. Age ≥65 years was a clinical entry criterion. After 3 months of dual-antiplatelet therapy with ticagrelor, event-free patients were randomized to ticagrelor plus placebo or ticagrelor plus aspirin for an additional 12 months. The primary endpoint was Bleeding Academic Research Consortium type 2, 3, or 5 bleeding. The key secondary endpoint was the composite of all-cause death, myocardial infarction, or stroke. A total of 3,113 patients (47.7%) were ≥65 years of age. At 1 year after randomization, ticagrelor monotherapy significantly reduced BARC type 2, 3, or 5 bleeding (4.5% vs. 8.2%; hazard ratio: 0.53; 95% confidence interval: 0.40 to 0.71) without increasing ischemic events (4.2% vs. 4.4%; hazard ratio: 0.96; 95% confidence interval: 0.68 to 1.35) compared with ticagrelor plus aspirin among patients ≥65 years of age. These findings were consistent in patients