Clinically Driven Revascularization in High-Risk Patients Treated With Ticagrelor Monotherapy After PCI: Insights from the Randomized TWILIGHT Trial

Usman Baber, Alessandro Spirito, Samantha Sartori, Dominick J. Angiolillo, Carlo Briguori, David J. Cohen, Timothy Collier, George Dangas, Dariusz Dudek, Javier Escaned, C. Michael Gibson, Ya Ling Han, Kurt Huber, Adnan Kastrati, Upendra Kaul, Ran Kornowski, Mitchell Krucoff, Vijay Kunadian, Birgit Vogel, Shamir R. MehtaDavid Moliterno, Gennaro Sardella, Richard A. Shlofmitz, Samin Sharma, Philippe Gabriel Steg, Stuart Pocock, Roxana Mehran

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


Repeat coronary revascularization is a common adverse event after successful percutaneous coronary intervention. This analysis aimed to assess the effects of ticagrelor monotherapy on repeat clinically driven revascularization (CDR). In the TWILIGHT (Ticagrelor With Aspirin or Alone in High-Risk Patients after Coronary Intervention) trial, after 3 months of ticagrelor plus aspirin, high-risk patients were maintained on ticagrelor and randomly allocated to aspirin or placebo for 1 year. The primary end point of this analysis was CDR within 12 months after randomization. The key secondary end points were major adverse cardiovascular and cerebrovascular events (MACCEs), a composite of all-cause death, myocardial infarction, stroke, or CDR, and net adverse clinical events (NACEs), including the individual components of MACCEs and clinically relevant bleeding. The analysis was performed in the per-protocol population. CDR occurred in 473 of 7,039 patients and was associated with a significantly higher risk of subsequent all-cause death, myocardial infarction, or stroke (adjusted hazard ratios [HRs] 2.92, 95% confidence interval [CI] 1.82 to 4.67). Ticagrelor monotherapy was associated with a similar 12-month risk of CDR (7.1% vs 6.6%; HR 1.09, 95% CI 0.90 to 1.30, p = 0.363) and MACCEs (8.9% vs 8.6%; HR 1.04, 95% CI 0.89 to 1.22, p = 0.619), and a lower risk of NACEs (12.2% vs 14.6%; HR 0.83 95% CI 0.73 to 0.94, p = 0.004) than ticagrelor plus aspirin. In conclusion, among high-risk patients who underwent percutaneous coronary intervention, ticagrelor monotherapy after 3 months of ticagrelor-based dual antiplatelet therapy was associated with a similar risk of CDR and MACCEs and a decrease of NACEs (TWILIGHT: NCT02270242).

Original languageEnglish
Pages (from-to)16-24
Number of pages9
JournalAmerican Journal of Cardiology
StatePublished - Dec 1 2023

Bibliographical note

Publisher Copyright:
© 2023 Elsevier Inc.


  • clinically driven revascularization
  • percutaneous coronary intervention
  • repeat revascularization
  • ticagrelor monotherapy

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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