In parallel to the TWILIGHT in patients with complex PCI, Dr. Angiolillo virtually presented the sub-study in diabetic patients, and it was published simultaneously in J Am Coll Cardiol. This study focuses on the clinical complexity of patients, rather than the technical complexity of the procedure itself. 

The TWILIGHT-DM analyzed 2620 diabetic patients from the general study randomized to ticagrelor monotherapy vs. dual antiaggregation. Before randomization, all patients complied with a three-month dual antiaggregation period which saw no thrombotic or bleeding events. 

In this cohort of diabetic patients there was a similar reduction of BARC 2, 3 or 5 bleeding (4.5% vs 6.7%; HR 0.65; CI 95% 0.47-0.91) and BARC 3 to 5 (1.1% vs 3.1%; HR 0.34; CI 95% 0.19-0.63) with ticagrelor monotherapy vs. ticagrelor + aspirin. 

Same as in the general study and all sub-studies, there were no differences in death, MI or stroke between arms (4.6% vs 5.9%; HR 0.77; CI 95% 0.55-1.09). These findings continue to be true when comparing against the non-diabetic cohort. 

Original Title: Ticagrelor with or without aspirin in high-risk patients with diabetes mellitus undergoing percutaneous coronary intervention.

Reference: Angiolillo DJ et al. J Am Coll Cardiol. 2020; Epub ahead of print y presentado en el ACC 2020 en forma virtual.

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