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

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...

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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
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creator 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
description 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 
doi_str_mv 10.1016/j.jcin.2021.04.043
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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 &lt;65 years of age with respect to the primary (p  = 0.62) and key secondary (p  = 0.77) endpoints and across different age categories. 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subjects Age Factors
Aged
Aspirin - adverse effects
Drug Therapy, Combination
Humans
Percutaneous Coronary Intervention
Platelet Aggregation Inhibitors - adverse effects
Ticagrelor - adverse effects
Treatment Outcome
title Impact of Age on the Safety and Efficacy of Ticagrelor Monotherapy in Patients Undergoing PCI
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