Safety and efficacy of ticagrelor monotherapy according to drug-eluting stent type: the TWILIGHT-STENT study

George Dangas, Usman Baber, Samin Sharma, Gennaro Giustino, Samantha Sartori, Johny Nicolas, Ridhima Goel, Shamir Mehta, David Cohen, Dominick J. Angiolillo, Zhongjie Zhang, Anton Camaj, Davide Cao, Carlo Briguori, Dariusz Dudek, Javier Escaned, Kurt Huber, Timothy Collier, Ran Kornowski, Vijay KunadianDavid J. Moliterno, E. Magnus Ohman, Giora Weisz, Robert Gil, Mitchell W. Krucoff, Upendra Kaul, Keith G. Oldroyd, Gennaro Sardella, Richard Shlofmitz, Bernhard Witzenbichler, Adnan Kastrati, Ya Ling Han, Philippe Gabriel Steg, Stuart Pocock, C. Michael Gibson, Roxana Mehran

Research output: Contribution to journalArticlepeer-review

9 Scopus citations


Background: In the TWILIGHT trial, ticagrelor monotherapy after a short course of dual antiplatelet therapy (DAPT) was shown to be a safe bleeding avoidance strategy in high-risk patients undergoing percutaneous coronary intervention (PCI) with drug-eluting stents (DES). Aims: The aim of this study was to evaluate the effects of ticagrelor monotherapy after three-month DAPT in patients undergoing PCI, according to DES type. Methods: In the current sub-analysis from TWILIGHT, patients were stratified into three groups based on DES type: durable polymer everolimus-eluting stents (DP-EES), durable polymer zotarolimus-eluting stents (DP-ZES), and biodegradable polymer DES (BP-DES). Bleeding and ischaemic outcomes were assessed at one year after randomisation. Results: Out of 5,769 patients, 3,014 (52.2%) had DP-EES, 1,350 (23.4%) had DP-ZES and 1,405 (24.4%) had BP-DES. Compared with ticagrelor plus aspirin, ticagrelor monotherapy had significantly lower BARC type 2, 3 or 5 bleeding compared with DAPT; DP-EES (3.8% vs 6.7%; HR 0.56, 95% CI: 0.41-0.78), DP-ZES (4.6% vs 6.9%; HR 0.66, 95% CI: 0.42-1.04) and BP-DES (4.2% vs 7.9%; HR 0.52, 95% CI: 0.33-0.81; pinteraction=0.76). Ticagrelor monotherapy resulted in similar rates of death, MI, or stroke: DP-EES (4.2% vs 4.3%; HR 0.97; 95% CI: 0.68-1.37); DP-ZES (4.1% vs 3.1%; HR 1.32; 95% CI: 0.75-2.33); BP-DES (3.9% vs 4.2%; HR 0.92; 95% CI: 0.54-1.55; pinteraction=0.60). In both unadjusted and covariateadjusted analyses, DES type was not associated with any differences in ischaemic or bleeding complications. Conclusions: As compared with ticagrelor plus aspirin, ticagrelor monotherapy after a short DAPT duration lowered bleeding complications without increasing the ischaemic risk, irrespective of DES type. We observed no significant differences among DES types.

Original languageEnglish
Pages (from-to)130-1339
Number of pages1210
Issue number16
StatePublished - Mar 2022


  • adjunctive pharmacotherapy
  • bleeding
  • clinical trials
  • drug-eluting stent


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