P1228 Outcome differences in women and men after early percutaneous coronary intervention in high-risk patients with acute coronary syndromes

2003 ◽  
Vol 24 (5) ◽  
pp. 232
Author(s):  
M LOUTFI
Keyword(s):  
Percutaneous Coronary Intervention ◽  
High Risk ◽  
Acute Coronary Syndromes ◽  
Coronary Intervention ◽  
High Risk Patients ◽  
Percutaneous Coronary ◽  
Risk Patients ◽  
Coronary Syndromes ◽  
Outcome Differences

TWILIGHT: A Randomized Trial of Ticagrelor Monotherapy Versus Ticagrelor Plus Aspirin Beginning at 3 Months in High-risk Patients Undergoing Percutaneous Coronary Intervention

2020 ◽  
Vol 14 ◽  
Author(s):  
Johny Nicolas ◽  
Usman Baber ◽  
Roxana Mehran
Keyword(s):  
Percutaneous Coronary Intervention ◽  
High Risk ◽  
Antiplatelet Therapy ◽  
Dual Antiplatelet Therapy ◽  
Coronary Intervention ◽  
Bleeding Events ◽  
High Risk Patients ◽  
Risk Of Death ◽  
Percutaneous Coronary ◽  
Risk Patients

A P2Y12 inhibitor-based monotherapy after a short period of dual antiplatelet therapy is emerging as a plausible strategy to decrease bleeding events in high-risk patients receiving dual antiplatelet therapy after percutaneous coronary intervention. Ticagrelor With Aspirin or Alone in High-Risk Patients After Coronary Intervention (TWILIGHT), a randomized double-blind trial, tested this approach by dropping aspirin at 3 months and continuing with ticagrelor monotherapy for an additional 12 months. The study enrolled 9,006 patients, of whom 7,119 who tolerated 3 months of dual antiplatelet therapy were randomized after 3 months into two arms: ticagrelor plus placebo and ticagrelor plus aspirin. The primary endpoint of interest, Bleeding Academic Research Consortium type 2, 3, or 5 bleeding, occurred less frequently in the experimental arm (HR 0.56; 95% CI [0.45–0.68]; p<0.001), whereas the secondary endpoint of ischemic events was similar between the two arms (HR 0.99; 95% CI [0.78–1.25]). Transition from dual antiplatelet therapy consisting of ticagrelor plus aspirin to ticagrelor-based monotherapy in high-risk patients at 3 months after percutaneous coronary intervention resulted in a lower risk of bleeding events without an increase in risk of death, MI, or stroke.

Percutaneous coronary interventions in acute coronary syndromes

2016 ◽  
Author(s):  
Viktor Kočka ◽  
Steen Dalby Kristensen ◽  
William Wijns ◽  
Petr Toušek ◽  
Petr Widimský
Keyword(s):  
Percutaneous Coronary Intervention ◽  
High Risk ◽  
Coronary Angiography ◽  
Acute Coronary Syndromes ◽  
Coronary Intervention ◽  
St Segment Elevation ◽  
St Segment ◽  
Percutaneous Coronary ◽  
Risk Criterion ◽  
Coronary Syndromes

Three different guidelines of the European Society of Cardiology cover the field of percutaneous coronary interventions. Their main recommendations are the following:All patients with an ST-segment elevation myocardial infarction should undergo immediate coronary angiography and percutaneous coronary intervention as soon as possible after the first medical contact. Thrombolysis can be used as an alternative reperfusion therapy if the time delay to primary percutaneous coronary intervention is more than 2 hoursPatients with very high-risk non-ST-segment elevation acute coronary syndromes (recurrent or ongoing chest pain, profound or dynamic electrocardiogram changes, major arrhythmias, or haemodynamic instability) should undergo urgent coronary angiography within less than 2 hours after the initial hospital admissionAll moderate- to high-risk (GRACE score >140 or at least one primary high-risk criterion) non-ST-segment elevation acute coronary syndromes patients should undergo coronary angiography before discharge; the ideal timing is within 24 hours after admission for high-risk groups, and within 72 hours for moderate-risk groupsOther patients with recurrent symptoms or at least one high-risk criterion should undergo coronary angiography within 72 hours of first presentationLow-risk non-ST-segment elevation acute coronary syndromes may be treated conservatively, and the indication for an invasive evaluation can be done, based on the evidence of ischaemia during exercise stress testingStents should be used during all percutaneous coronary intervention procedures, whenever technically feasible. Second-generation drug-eluting stents do not increase stent thrombosis and can be safely used in the ST-segment elevation myocardial infarction and non-ST-segment elevation acute coronary syndrome settingsTriple pharmacotherapy, consisting of aspirin, thienopyridine antiplatelet agent, and anticoagulation with heparin or bivalirudin, should be used in all percutaneous coronary intervention procedures, with glycoprotein IIb/IIIa inhibitors added in patients with a high thrombus burden and low bleeding risk

scholarly journals 291 Ticagrelor monotherapy after percutaneous coronary intervention in high-risk patients with prior myocardial infarction: a prespecified twilight substudy

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Mauro Chiarito ◽  
Davide Cao ◽  
Usman Baber ◽  
Carlo Pivato ◽  
Carlo Briguori ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
High Risk ◽  
Coronary Intervention ◽  
Bleeding Events ◽  
High Risk Patients ◽  
Percutaneous Coronary ◽  
Risk Patients ◽  
History Of ◽  
The Impact

Abstract Aims Patients with history of myocardial infarction (MI) undergoing percutaneous coronary intervention (PCI) remain at risk of recurrent ischaemic events. The optimal antithrombotic strategy for this cohort remains debated. Methods and results In this prespecified analysis of the TWILIGHT trial, we evaluated the impact of prior MI on treatment effect of ticagrelor monotherapy vs. ticagrelor plus aspirin in patients undergoing PCI with at least one clinical and one angiographic high-risk feature and free from adverse events at 3 months after the index PCI. The primary endpoint was Bleeding Academic Research Consortium (BARC) type 2, 3, or 5, the key secondary endpoint was the composite of all-cause death, MI, or stroke, both at 12 months after randomization. 1937 (29.7%) patients with and 4595 (70.3%) without prior MI were randomized to ticagrelor and placebo or ticagrelor and aspirin. Patients with prior MI had increased rates of death, MI or stroke (5.7 vs. 3.2%, P &lt; 0.001) but similar BARC 2–5 bleeding (5.0 vs. 5.5%, P = 0.677). Ticagrelor monotherapy reduced the risk of BARC 2–5 bleeding in patients with [3.4% vs. 6.7%; hazard ratio (HR): 0.50; 95% confidence interval (CI): 0.33–0.76] and without prior MI [4.2% vs. 7.0%; HR: 0.58; 95% CI: 0.45–0.76; pinteraction = 0.54). Rates of the key secondary ischaemic outcome were similar between treatment groups irrespective of history of MI (prior MI: 6.0% vs. 5.5%; HR: 1.09; 95% CI: 0.75–1.58; no prior MI: 3.1% vs. 3.3%; HR: 0.92; 95% CI: 0.67–1.28; pinteraction = 0.52). Conclusions Ticagrelor monotherapy is associated with significantly lower risk of bleeding events as compared to ticagrelor plus aspirin without any compromise in ischaemic prevention among high-risk patients with history of MI undergoing PCI.

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