The TWILIGHT study (NCT02270242) was a blinded dual-arm study comparing the use of ticagrelor plus aspirin with the use of ticagrelor plus a placebo (ticagrelor monotherapy) for 1 year in high-risk patients who had undergone PCI and had already completed 3 months of dual antiplatelet therapy. TWILIGHT demonstrated that the risk of bleeding could be decreased without a corresponding increased risk of an ischaemic event.
Dr Birgit Vogel (Icahn School of Medicine, USA) presented a pre-planned sub-group analysis that explored any heterogeneity of outcomes between the sexes. The investigators stratified outcomes by sex according to 2 endpoints among the 7,119 randomised participants. The 2 endpoints of this analysis were a primary bleeding event (defined as Bleeding Academic Research Consortium type 2, 3, or 5 bleeding) at 1 year, and a primary ischaemic event (defined as a composite of death, myocardial infarction, or stroke) at 1 year.
Women more frequently experienced the primary bleeding endpoint than men (HR 1.32; 95% CI 1.06-1.64; P=0.01). However, after multivariate adjustment, this increased risk was deemed not significant (adjusted HR 1.20; 95%CI 0.95-1.52; P=0.12). The ischaemic endpoints were similar between the sexes.
Researchers concluded that the clinical benefits of withdrawal of aspirin therapy following 3 months of dual antiplatelet therapy were generally the same in men and women, and that further studies should be done to explore these benefits in women.
- Vogel B. Sex-Specific Outcomes in High-Risk Patients Receiving Ticagrelor with or without Aspirin After Percutaneous Coronary Intervention: Results from the TWILIGHT Study. ACC 2021 Scientific Session, 15-17 May.
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Table of Contents: ACC 2021
Featured articles
Electrophysiology
Favourable outcomes with transcatheter atrial appendage occlusion
Etripamil nasal spray significantly improves PSVT-related symptoms
Ablation-based rhythm control as effective as rate control in AF and HF
Finerenone reduces the risk of AF onset in patients with CKD and diabetes
Heart Failure and Cardiomyopathy
PARADISE-MI: Sacubitril/valsartan not superior to ramipril in reducing HF events
Older adults with heart failure benefit from rehabilitation programme
Quality improvement intervention fails to improve care for patients with heart failure
Sacubitril/valsartan does not reduce NT-proBNP versus valsartan alone in HFrEF
Novel use of ivabradine in reversible cardiomyopathy
Mavacamten significantly improves QoL of patients with hypertrophic cardiomyopathy
Interventional and Structural Cardiology
Men and women benefit equally from early aspirin withdrawal following PCI
Similar outcomes with fractional flow reserve and angiography-guided revascularisation
TALOS-AMI: Exploring outcomes after switching to clopidogrel versus ticagrelor at 1 month from MI
Clopidogrel monotherapy associated with better net outcomes relative to aspirin monotherapy 6-18 months after PCI
Ischaemic Heart Disease
No difference in ischaemic risk or bleeding with low vs high-dose aspirin for secondary prevention: Lessons and questions from the ADAPTABLE trial
Rivaroxaban reduces total ischaemic events after peripheral artery revascularisation
Moderate hypothermia not superior to mild hypothermia following out-of-hospital cardiac arrest
Better outcomes with invasive strategy if anatomic complete revascularisation is possible
Prevention and Health Promotion
STRENGTH trial fails to demonstrate cardioprotective effect of omega-3 fatty acids
Evinacumab lowers triglyceride levels in severe hypertriglyceridaemia
Health equity and the role of the cardiologist: 7 priorities to consider
COVID-19
Dapagliflozin fails to show a significant protective effect in COVID-19
Therapeutic anticoagulation not superior to prophylactic anticoagulation in COVID-19
Atorvastatin does not reduce mortality in COVID-19
Valvular Heart Disease
Apixaban outcomes similar to current standard of care following TAVR
Preliminary results encouraging for EVOQUE tricuspid valve replacement
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