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Long-term ticagrelor for secondary prevention in patients with prior myocardial infarction and no history of coronary stenting: insights from PEGASUS-TIMI 54
RHM. Furtado, JC. Nicolau, G. Magnani, K. Im, DL. Bhatt, RF. Storey, PG. Steg, J. Spinar, A. Budaj, F. Kontny, R. Corbalan, RG. Kiss, MT. Abola, P. Johanson, EC. Jensen, E. Braunwald, MS. Sabatine, MP. Bonaca
Language English Country Great Britain
Document type Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't
NLK
Free Medical Journals
from 1996 to 1 year ago
Open Access Digital Library
from 1996-01-01
- MeSH
- Adenosine therapeutic use MeSH
- Purinergic P2Y Receptor Antagonists * therapeutic use MeSH
- Myocardial Infarction * drug therapy prevention & control MeSH
- Platelet Aggregation Inhibitors adverse effects MeSH
- Drug Therapy, Combination MeSH
- Humans MeSH
- Secondary Prevention MeSH
- Ticagrelor therapeutic use MeSH
- Treatment Outcome MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
- Randomized Controlled Trial MeSH
AIMS: PEGASUS-TIMI 54 demonstrated that long-term dual antiplatelet therapy (DAPT) with aspirin and ticagrelor reduced the risk of major adverse cardiovascular events (MACE), with an acceptable increase in bleeding, in patients with prior myocardial infarction (MI). While much of the discussion around prolonged DAPT has been focused on stented patients, patients with prior MI without prior coronary stenting comprise a clinically important subgroup. METHODS AND RESULTS: This was a pre-specified analysis from PEGASUS-TIMI 54, which randomized 21 162 patients with prior MI (1-3 years) and additional high-risk features to ticagrelor 60 mg, 90 mg, or placebo twice daily in addition to aspirin. A total of 4199 patients had no history of coronary stenting at baseline. The primary efficacy outcome (MACE) was the composite of cardiovascular death, MI, or stroke. Patients without history of coronary stenting had higher baseline risk of MACE [13.2% vs. 8.0%, adjusted hazard ratio (HR) 1.41, 95% confidence interval (CI) 1.15-1.73, in the placebo arm]. The relative risk reduction in MACE with ticagrelor (pooled doses) was similar in patients without (HR 0.82, 95% CI 0.68-0.99) and with prior stenting (HR 0.85, 95% CI 0.75-0.96; P for interaction = 0.76). CONCLUSION: Long-term ticagrelor reduces thrombotic events in patients with prior MI regardless of whether they had prior coronary stenting. These data highlight the benefits of DAPT in prevention of spontaneous atherothrombotic events and indicate that long-term ticagrelor may be considered in high-risk patients with prior MI even if they have not been treated with stenting. CLINICALTRIALS.GOV IDENTIFIER: NCT01225562.
Assistance Publique Hôpitaux de Paris 3 Avenue Victoria 75004 Paris France
AstraZeneca 431 53 Mölndal Sweden
Centre of Postgraduate Medical Education Grochowski Hospital Grenadierów 51 59 04 073 Warsaw Poland
Department of Cardiology Military Hospital Róbert Károly krt 1134 Budapest Hungary
Drammen Heart Center Dronninggata 28 3004 Drammen Norway
University Hospital Brno 20 Jihlavska Brno Czech Republic
University Hospital of Parma Via Gramsci 14 43126 Parma PR Italy
References provided by Crossref.org
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