TY - JOUR
T1 - Bleeding and Ischemic Outcomes With Ticagrelor Monotherapy According to Body Mass Index
AU - Kunadian, Vijay
AU - Baber, Usman
AU - Pivato, Carlo A.
AU - Cao, Davide
AU - Dangas, George
AU - Sartori, Samantha
AU - Zhang, Zhongjie
AU - Angiolillo, Dominick J.
AU - Briguori, Carlo
AU - Cohen, David J.
AU - Collier, Timothy
AU - Dudek, Dariusz
AU - Gibson, Michael
AU - Gil, Robert
AU - Huber, Kurt
AU - Kaul, Upendra
AU - Kornowski, Ran
AU - Krucoff, Mitchell W.
AU - Dehghani, Payam
AU - Mehta, Shamir
AU - Moliterno, David J.
AU - Ohman, E. Magnus
AU - Escaned, Javier
AU - Sardella, Gennaro
AU - Sharma, Samin K.
AU - Shlofmitz, Richard
AU - Weisz, Giora
AU - Witzenbichler, Bernhard
AU - Džavík, Vladimír
AU - Gurbel, Paul
AU - Hamm, Christian W.
AU - Henry, Timothy
AU - Kastrati, Adnan
AU - Marx, Steven O.
AU - Oldroyd, Keith
AU - Steg, P. Gabriel
AU - Pocock, Stuart
AU - Mehran, Roxana
N1 - Publisher Copyright:
© 2022 American College of Cardiology Foundation
PY - 2022/10/10
Y1 - 2022/10/10
N2 - Background: There is a paucity of data regarding the safety and efficacy of different antiplatelet regimens according to standardized body mass index (BMI) categories. Objectives: The aim of this study was to investigate bleeding and ischemic outcomes according to BMI in the TWILIGHT (Ticagrelor With Aspirin or Alone in High-Risk Patients After Coronary Intervention) trial. Methods: The TWILIGHT trial randomized high-risk patients to ticagrelor plus aspirin or ticagrelor plus placebo at 3 months after percutaneous coronary intervention. In this secondary analysis, patients were stratified by standard BMI categories, as recommended by the European Society of Cardiology Working Group on Thrombosis (normal weight [BMI 18.5-24.99 kg/m2], overweight [BMI 25-29.99 kg/m2], and obese [BMI ≥30 kg/m2]) and by median BMI, as prespecified in the protocol. Results: Among 7,038 patients randomized and with available BMI, 1,807 (25.7%) were normal weight, 2,927 (41.6%) were overweight, and 2,304 (32.7%) were obese. In normal-weight, overweight, and obese patients, ticagrelor monotherapy, compared with ticagrelor plus aspirin, reduced the primary endpoint of Bleeding Academic Research Consortium type 2, 3, or 5 bleeding (normal weight: HR: 0.48 [95% CI: 0.32-0.73]; overweight: HR: 0.57 [95% CI: 0.41-0.78]; obese: HR: 0.63 [95% CI: 0.44-0.91]; P for interaction = 0.627), without any increase in the composite ischemic endpoint of all-cause death, myocardial infarction, or stroke (normal weight: HR: 1.36 [95% CI: 0.84-2.19]; overweight: HR: 0.92 [95% CI: 0.63-1.35]; obese: HR: 0.84 [95% CI: 0.56-1.25]; P for interaction = 0.290). These findings were consistent with the prespecified analysis by median BMI. Conclusions: Among high-risk patients undergoing percutaneous coronary intervention, ticagrelor monotherapy, compared with ticagrelor plus aspirin, reduced bleeding events without any increase in ischemic risk across different BMI categories.
AB - Background: There is a paucity of data regarding the safety and efficacy of different antiplatelet regimens according to standardized body mass index (BMI) categories. Objectives: The aim of this study was to investigate bleeding and ischemic outcomes according to BMI in the TWILIGHT (Ticagrelor With Aspirin or Alone in High-Risk Patients After Coronary Intervention) trial. Methods: The TWILIGHT trial randomized high-risk patients to ticagrelor plus aspirin or ticagrelor plus placebo at 3 months after percutaneous coronary intervention. In this secondary analysis, patients were stratified by standard BMI categories, as recommended by the European Society of Cardiology Working Group on Thrombosis (normal weight [BMI 18.5-24.99 kg/m2], overweight [BMI 25-29.99 kg/m2], and obese [BMI ≥30 kg/m2]) and by median BMI, as prespecified in the protocol. Results: Among 7,038 patients randomized and with available BMI, 1,807 (25.7%) were normal weight, 2,927 (41.6%) were overweight, and 2,304 (32.7%) were obese. In normal-weight, overweight, and obese patients, ticagrelor monotherapy, compared with ticagrelor plus aspirin, reduced the primary endpoint of Bleeding Academic Research Consortium type 2, 3, or 5 bleeding (normal weight: HR: 0.48 [95% CI: 0.32-0.73]; overweight: HR: 0.57 [95% CI: 0.41-0.78]; obese: HR: 0.63 [95% CI: 0.44-0.91]; P for interaction = 0.627), without any increase in the composite ischemic endpoint of all-cause death, myocardial infarction, or stroke (normal weight: HR: 1.36 [95% CI: 0.84-2.19]; overweight: HR: 0.92 [95% CI: 0.63-1.35]; obese: HR: 0.84 [95% CI: 0.56-1.25]; P for interaction = 0.290). These findings were consistent with the prespecified analysis by median BMI. Conclusions: Among high-risk patients undergoing percutaneous coronary intervention, ticagrelor monotherapy, compared with ticagrelor plus aspirin, reduced bleeding events without any increase in ischemic risk across different BMI categories.
KW - aspirin
KW - body mass index
KW - coronary artery disease
KW - dual antiplatelet therapy
KW - percutaneous coronary intervention
KW - ticagrelor
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U2 - 10.1016/j.jcin.2022.07.039
DO - 10.1016/j.jcin.2022.07.039
M3 - Article
C2 - 36202563
AN - SCOPUS:85138423459
SN - 1936-8798
VL - 15
SP - 1948
EP - 1960
JO - JACC: Cardiovascular Interventions
JF - JACC: Cardiovascular Interventions
IS - 19
ER -