Division of Cardiology, University of Florida College of Medicine, Jacksonville, Florida, USA.
The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy.
JACC Cardiovasc Interv. 2023 Oct 23;16(20):2514-2524. doi: 10.1016/j.jcin.2023.08.019.
Nearly 20% of patients on ticagrelor experience dyspnea, which may lead to treatment discontinuation in up to one-third of cases.
The authors sought to evaluate the incidence, predictors, and outcomes of dyspnea-related ticagrelor discontinuation after percutaneous coronary intervention (PCI).
In the TWILIGHT (Ticagrelor With Aspirin or Alone in High-Risk Patients After Coronary Intervention) trial, after 3 months of ticagrelor plus aspirin, patients were maintained on ticagrelor and randomized to aspirin or placebo for 1 year. The occurrence of dyspnea associated with ticagrelor discontinuation was evaluated among all patients enrolled in the trial. A landmark analysis was performed at 3 months after PCI, that is, the time of randomization. Predictors of dyspnea-related ticagrelor discontinuation were obtained from multivariable Cox regression with stepwise selection of candidate variables.
The incidence of dyspnea-related ticagrelor discontinuation was 6.4% and 9.1% at 3 and 15 months after PCI, respectively. Independent predictors included Asian race (lower risk), smoking, prior PCI, hypercholesterolemia, prior coronary artery bypass, peripheral artery disease, obesity, and older age. Among 179 patients who discontinued ticagrelor because of dyspnea after randomization, ticagrelor monotherapy was not associated with a higher risk of subsequent ischemic events (composite of all-cause death, myocardial infarction, or stroke) compared with ticagrelor plus aspirin (5.0% vs 7.1%; P = 0.566).
In the TWILIGHT trial, dyspnea-related ticagrelor discontinuation occurred in almost 1 in 10 patients and tended to occur earlier rather than late after PCI. Several demographic and clinical conditions predicted its occurrence, and their assessment may help identify subjects at risk for therapy nonadherence.
近 20%的替格瑞洛患者出现呼吸困难，这可能导致多达三分之一的患者停止治疗。
作者旨在评估经皮冠状动脉介入治疗（PCI）后与呼吸困难相关的替格瑞洛停药的发生率、预测因素和结局。
在 TWILIGHT（替格瑞洛与阿司匹林或单独用于高危患者经皮冠状动脉介入治疗后）试验中，替格瑞洛加阿司匹林治疗 3 个月后，患者继续使用替格瑞洛，并随机分为阿司匹林或安慰剂治疗 1 年。在所有入组患者中评估与替格瑞洛停药相关的呼吸困难发生情况。在 PCI 后 3 个月进行了里程碑式分析，即随机分组的时间。采用逐步选择候选变量的多变量 Cox 回归获得与呼吸困难相关的替格瑞洛停药的预测因素。
在 PCI 后 3 个月和 15 个月时，呼吸困难相关的替格瑞洛停药发生率分别为 6.4%和 9.1%。独立预测因素包括亚洲种族（风险较低）、吸烟、既往 PCI、高胆固醇血症、既往冠状动脉旁路移植术、外周动脉疾病、肥胖和年龄较大。在 179 名因呼吸困难在随机分组后停用替格瑞洛的患者中，与替格瑞洛加阿司匹林相比，替格瑞洛单药治疗与随后发生缺血事件（全因死亡、心肌梗死或中风的复合终点）的风险增加无关（5.0% vs 7.1%；P = 0.566）。
在 TWILIGHT 试验中，与呼吸困难相关的替格瑞洛停药发生在近 10 名患者中的近 1 名，且往往发生在 PCI 后较早而非较晚。一些人口统计学和临床状况预测了其发生，对这些因素的评估可能有助于识别治疗不依从的风险患者。
