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Dyspnea-Related Ticagrelor Discontinuation After Percutaneous Coronary Intervention
Dominick J Angiolillo1, Davide Cao2, Samantha Sartori3
1Division of Cardiology, University of Florida College of Medicine, Jacksonville, Florida, USA.
Insights
Dyspnea is a common side effect of ticagrelor, leading to discontinuation in many patients after percutaneous coronary intervention (PCI). Identifying predictors of this side effect can help manage treatment adherence.
Area of Science:
- Cardiology
- Pharmacology
- Clinical Trials
Background:
- Dyspnea affects nearly 20% of patients taking ticagrelor.
- This side effect can lead to treatment discontinuation in up to one-third of affected patients.
Purpose of the Study:
- To evaluate the incidence, predictors, and outcomes of dyspnea-related ticagrelor discontinuation.
- To analyze data from the TWILIGHT trial.
Main Methods:
- Utilized data from the TWILIGHT trial, randomizing patients to ticagrelor plus aspirin or ticagrelor alone after initial treatment.
- Performed a landmark analysis at 3 months post-PCI.
- Employed multivariable Cox regression to identify predictors of dyspnea-related discontinuation.
Main Results:
- The incidence of dyspnea-related ticagrelor discontinuation was 6.4% at 3 months and 9.1% at 15 months post-PCI.
- Predictors included Asian race (lower risk), smoking, prior PCI, hypercholesterolemia, prior coronary artery bypass, peripheral artery disease, obesity, and older age.
- Discontinuing ticagrelor due to dyspnea did not increase the risk of subsequent ischemic events compared to continuing dual therapy.
Conclusions:
- Dyspnea-related ticagrelor discontinuation affects nearly 10% of patients, often occurring early after PCI.
- Identifying demographic and clinical predictors aids in managing patients at risk for nonadherence.
Background:
Nearly 20% of patients on ticagrelor experience dyspnea, which may lead to treatment discontinuation in up to one-third of cases.
Objectives:
The authors sought to evaluate the incidence, predictors, and outcomes of dyspnea-related ticagrelor discontinuation after percutaneous coronary intervention (PCI).
Methods:
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.
Results:
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).
Conclusions:
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.
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