The original TWILIGHT findings in more than 9000 patients who underwent angioplasty were presented last year at TCT and showed a 3.1% absolute risk reduction in BARC 2, 3, or 5 bleeding with no increase in death, infarction, or stroke in patients who received ticagrelor and placebo compared with patients who received ticagrelor and aspirin. All patients had previously received dual antiplatelet therapy for 3 months and had not experienced any bleeding or thrombotic events during that period of time.

Now, the TWILIGHT-COMPLEX trial is presented at the virtual ACC 2020 virtual while simultaneously published in J Am Coll Cardiol. This study focused on 2343 patients from the original TWILIGHT trial, who underwent complex angioplasty defined as: 3 vessels treated (9.1%), ≥3 lesions treated (29.9%), total stent length >60 mm (51.8%), bifurcation lesion with 2 stents implanted (10.7%); use of any atherectomy device (10.4%), left main disease (15.1%), venous or arterial bypass graft (6.9%), and chronic total occlusion (19%).

Compared with the main TWILIGHT population, these patients were older and more likely to have chronic kidney disease or anemia, and present acute coronary syndrome.

The primary endpoint of BARC 2, 3, or 5 bleeding was 4.2% in patients with complex angioplasty in the ticagrelor monotherapy group vs. 7.7% in patients in the dual antiplatelet therapy group (a similar reduction to that experienced by patients who underwent noncomplex angioplasty). A similar finding was observed for major (BARC 3 to 5) bleeding only.

Read also: Virtual ACC 2020 | First Results of Evolut in Low-Risk Bicuspid Valves.

Just like in the general population, there were also no differences in death, infarction, or stroke between ticagrelor monotherapy and dual antiplatelet therapy, and the same happened with definite/probable thrombosis.

Original Title: Ticagrelor with aspirin or alone after complex PCI: the TWILIGHT-COMPLEX analysis.

Reference: Dangas G et al. J Am Coll Cardiol. 2020; Epub ahead of print y presentado en el ACC 2020.

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