Ticagrelor monotherapy versus ticagrelor plus aspirin in patients with chronic coronary syndrome and high ischaemic risk: a post hoc analysis of the TWILIGHT trial
Authors' conclusion
In a post hoc analysis of the TWILIGHT trial that included CCS patients undergoing PCI, ticagrelor monotherapy after 3 months of DAPT appeared to be safe and was not associated with increased risks of ischaemic or bleeding events, regardless of baseline HIR status, compared with standard ticagrelor-based DAPT. These findings suggest the potential to expand guideline recommendations for ticagrelor monotherapy in CCS.
Study context
- Population
- Patients with chronic coronary syndrome (CCS) undergoing percutaneous coronary intervention (PCI), stratified by high ischaemic risk (HIR) per the 2019 European Society of Cardiology (ESC) CCS guidelines definitionCCS patients who underwent randomisation · HIR 1,264 · non-HIR 1,239
- Participants
- 2,503 patients
- Comparison
- Ticagrelor monotherapy with ticagrelor-based dual antiplatelet therapy (DAPT) in CCS patients with and without HIR undergoing PCI
Methodological detailsrandomised
- Randomised
Primary result
As reported in the abstract
MACCE (death, myocardial infarction or stroke), HIR vs non-HIR patients · 1 year
Further findings
| Outcome | Ticagrelor monotherapy | Ticagrelor-based DAPT | HR (95% CI) | |
|---|---|---|---|---|
| MACCE, by HIR status · 1 yearHIR | 4.0% | 3.8% | 1.06 (0.60–1.85) | |
| MACCE, by HIR status · 1 yearnon-HIR | 2.1% | 2.6% | 0.80 (0.38–1.66) | |
| 0.20.5125Hazard ratio (log scale) |
- Bleeding Academic Research Consortium (BARC) Type 2-5 bleeding, HIR vs non-HIR patients: HIR 5.1%
- BARC Type 2-5 bleeding, HIR vs non-HIR patients: non-HIR 5.7%
- BARC Type 2-5 bleeding, HIR vs non-HIR patients: p=0.455
- Major adverse cardiac and cerebrovascular events (MACCE), by HIR status: pinteraction=0.553
Safety
| Outcome | Ticagrelor monotherapy | Ticagrelor-based DAPT | HR (95% CI) | |
|---|---|---|---|---|
| BARC Type 2-5 bleeding, by HIR status · 1 yearHIR | 4.7% | 5.7% | 0.82 (0.50–1.33) | |
| BARC Type 2-5 bleeding, by HIR status · 1 yearnon-HIR | 4.9% | 6.7% | 0.71 (0.44–1.14) | |
| 0.512Hazard ratio (log scale) |
- BARC Type 2-5 bleeding, by HIR status: pinteraction=0.684
Original publication
Ticagrelor monotherapy versus ticagrelor plus aspirin in patients with chronic coronary syndrome and high ischaemic risk: a post hoc analysis of the TWILIGHT trial. EuroIntervention. Published 16 May 2025. doi:10.
Summarised from the published abstract; every number is checked against it