The TWILIGHT trial reveals the effect of DAPT and ticagrelor monotherapy after percutaneous coronary intervention


New insights from the TWILIGHT trial showed that ticagrelor monotherapy three months after ticagrelor plus aspirin was associated with similar rates of recurrent coronary revascularization, significant adverse cardiovascular events (MACCE) and a reduced risk of net adverse clinical events (NACE) compared with antiplatelet therapy Dual (DAPT). Results of a randomized controlled trial of more than 7,000 patients were presented today as recent clinical research at the Scientific Society for Cardiovascular Imaging and Interventions (SCAI) 2023 Sessions.

Despite advances in percutaneous coronary intervention (PCI) techniques, devices, and secondary prevention, revascularization frequency remains a concern and is associated with increased morbidity, hospitalization, and healthcare costs.

In the TWILIGHT trial, high-risk patients who were event-free and adherent to a ticagrelor-based DAPT for three months after PCI were randomized to ticagrelor plus aspirin or ticagrelor plus placebo for an additional 12 months. The primary endpoint was revascularization due to recurrent or persistent myocardial ischemia. Secondary endpoints included targeted revascularization (TLR), targeted revascularization (TVR), negative cardiovascular and cerebrovascular adverse events (MACCE) and net negative clinical events (NACE). All endpoints were adjudicated and evaluated at 12 months after randomization in the per-protocol population.

Among 7039 patients, ticagrelor and ticagrelor plus aspirin monotherapy were associated with a similar risk of recurrence of revascularization (7.1% vs 6.6%, HR 1.09, 95% CI 0.90–1.30), TLR, TVR and MACCE, while NACE was lower with monotherapy. ticagrelor. The results also showed that clinically induced revascularization was associated with an increased risk of subsequent death, myocardial infarction, or stroke (aHR 2.92, 95% CI 1.82–4.67).

In high-risk patients, it is critical to reduce the incidence of recurrent vascular revascularization. The results presented today from the TWILIGHT trial provide a greater understanding of the impact of DAPT and ticagrelor monotherapy after PCI for the clinical community.”

Usman Baber, MD, assistant professor of medicine at the University of Oklahoma Health Sciences Center and lead author of the study


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