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  • In a nutshell: The...

In a nutshell: The hottest developments in the field of cardiology in 2020. Section 5. Coronary artery disease - Page 2

Written By : dr. Abhimanyu Uppal |Medically Reviewed By : Dr. Kamal Kant Kohli Published On 2020-12-31T11:00:04+05:30  |  Updated On 31 Dec 2020 12:55 PM IST
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3. TICO (Ticagrelor With or Without Aspirin in Acute Coronary Syndrome After Percutaneous Coronary Intervention) trial

Ticagrelor monotherapy after 3 months of DAPT was superior at preventing ischemia and bleeding after PCI for ACS.

Patients undergoing PCI for ACS were randomized to ticagrelor monotherapy after 3 months of DAPT versus standard therapy.

Among ACS patients who underwent PCI with an ultrathin biodegradable-polymer sirolimus-eluting stent, ticagrelor monotherapy after 3 months of DAPT was superior to standard therapy of DAPT for 12 months. Ticagrelor monotherapy was effective at preventing net composite ischemic and bleeding events.

Ticagrelor monotherapy appears to be an emerging strategy, especially for patients with increased bleeding risk, after a short duration of DAPT.

Unlike TWILIGHT trial, TICO included patients with STEMI also and hence widens the spectrum of ticagrelor montherapy use in acute coronary syndrome setting.

Taken together, the observations from TICO-STEMI appear to further highlight the need for optimal distinction between the risk factors of bleeding and ischemia in post-PCI patients. This is not an easy endeavour given the documented overlap between the two. However, it is a goal worth pursuing, as a proper stratification tool may have the capacity to improve prognosis given that both thrombotic and bleeding events are associated with increased mortality.

Source: JAMA cardiology: Kim B, Hong S, Cho Y, et al. The TICO Randomized Clinical Trial. JAMA. 2020;323(23):2407–2416. doi:10.1001/jama.2020.7580

4. TWILIGHT-COMPLEX (Ticagrelor With Aspirin or Alone in High-Risk Patients After Coronary Intervention) Substudy

Subgroups from TWILIGHT trial were analysed separately- NSTEMI, Diabetics, complex PCI cases.

TWILIGHT trial had earlier shown that short-duration DAPT (3 months) followed by ticagrelor monotherapy for 12 months results in less bleeding compared with longer-duration DAPT (additional 12 months) among patients undergoing PCI with a DES and at high ischemic or bleeding risk.

These results were maintained even among the subgroup of patients presenting with NSTE-ACS, diabetes mellitus, and those undergoing complex PCI in the TWILIGHT-COMPLEX substudy.

These are interesting findings, and help advance our understanding of the optimal duration and type of antiplatelet agent post-PCI.

Similar findings were noted with clopidogrel in the SMART-CHOICE and STOPDAPT-2 trials. These trials are thus likely to influence future guidelines regarding DAPT duration post-PCI.

Source: JACC: Angiolillo DJ, Baber U, Sartori S, et al. Ticagrelor With or Without Aspirin in High-Risk Patients With Diabetes Mellitus Undergoing Percutaneous Coronary Intervention. J Am Coll Cardiol 2020;Mar 30

latest cardiology developmentslatest cardiology trialsCoronary artery diseaseantiplateletsLeft main coronary artery diseasebifurcation lesions
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dr. Abhimanyu Uppal
dr. Abhimanyu Uppal

    MBBS, MD , DM Cardiology

    Dr Abhimanyu Uppal completed his M. B. B. S and M. D. in internal medicine from the SMS Medical College in Jaipur. He got selected for D. M. Cardiology course in the prestigious G. B. Pant Institute, New Delhi in 2017. After completing his D. M. Degree he continues to work as Post DM senior resident in G. B. pant hospital. He is actively involved in various research activities of the department and has assisted and performed a multitude of cardiac procedures under the guidance of esteemed faculty of this Institute. He can be contacted at editorial@medicaldialogues.in.

    Dr. Kamal Kant Kohli
    Dr. Kamal Kant Kohli

    Dr Kamal Kant Kohli-MBBS, DTCD- a chest specialist with more than 30 years of practice and a flair for writing clinical articles, Dr Kamal Kant Kohli joined Medical Dialogues as a Chief Editor of Medical News. Besides writing articles, as an editor, he proofreads and verifies all the medical content published on Medical Dialogues including those coming from journals, studies,medical conferences,guidelines etc. Email: drkohli@medicaldialogues.in. Contact no. 011-43720751

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