Bleeding and Ischemic Outcomes With Ticagrelor Monotherapy According to Body Mass Index.
;
Dariusz Dudek;
Michael Gibson;
Robert Gil;
Kurt Huber;
Upendra Kaul;
Ran Kornowski;
Mitchell W Krucoff;
Payam Dehghani;
Shamir Mehta;
David J Moliterno;
E Magnus Ohman;
Javier Escaned;
Gennaro Sardella;
Samin K Sharma;
Richard Shlofmitz;
Giora Weisz;
Bernhard Witzenbichler;
Vladimír Džavík;
Paul Gurbel;
Christian W Hamm;
Timothy Henry;
Adnan Kastrati;
Steven O Marx;
Keith Oldroyd;
P Gabriel Steg;
Stuart Pocock;
Roxana Mehran;
(2022)
Bleeding and Ischemic Outcomes With Ticagrelor Monotherapy According to Body Mass Index.
JACC: Cardiovascular Interventions, 15 (19).
pp. 1948-1960.
ISSN 1936-8798
DOI: 10.1016/j.jcin.2022.07.039
BACKGROUND: There is a paucity of data regarding the safety and efficacy of different antiplatelet regimens according to standardized body mass index (BMI) categories. OBJECTIVES: The aim of this study was to investigate bleeding and ischemic outcomes according to BMI in the TWILIGHT (Ticagrelor With Aspirin or Alone in High-Risk Patients After Coronary Intervention) trial. METHODS: The TWILIGHT trial randomized high-risk patients to ticagrelor plus aspirin or ticagrelor plus placebo at 3 months after percutaneous coronary intervention. In this secondary analysis, patients were stratified by standard BMI categories, as recommended by the European Society of Cardiology Working Group on Thrombosis (normal weight [BMI 18.5-24.99 kg/m2], overweight [BMI 25-29.99 kg/m2], and obese [BMI ≥30 kg/m2]) and by median BMI, as prespecified in the protocol. RESULTS: Among 7,038 patients randomized and with available BMI, 1,807 (25.7%) were normal weight, 2,927 (41.6%) were overweight, and 2,304 (32.7%) were obese. In normal-weight, overweight, and obese patients, ticagrelor monotherapy, compared with ticagrelor plus aspirin, reduced the primary endpoint of Bleeding Academic Research Consortium type 2, 3, or 5 bleeding (normal weight: HR: 0.48 [95% CI: 0.32-0.73]; overweight: HR: 0.57 [95% CI: 0.41-0.78]; obese: HR: 0.63 [95% CI: 0.44-0.91]; P for interaction = 0.627), without any increase in the composite ischemic endpoint of all-cause death, myocardial infarction, or stroke (normal weight: HR: 1.36 [95% CI: 0.84-2.19]; overweight: HR: 0.92 [95% CI: 0.63-1.35]; obese: HR: 0.84 [95% CI: 0.56-1.25]; P for interaction = 0.290). These findings were consistent with the prespecified analysis by median BMI. CONCLUSIONS: Among high-risk patients undergoing percutaneous coronary intervention, ticagrelor monotherapy, compared with ticagrelor plus aspirin, reduced bleeding events without any increase in ischemic risk across different BMI categories.
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