Long-Term Use of Ticagrelor in Patients with Prior Myocardial Infarction
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- 7 May 2015
- journal article
- research article
- Published by Massachusetts Medical Society in The New England Journal of Medicine
- Vol. 372 (19), 1791-1800
- https://doi.org/10.1056/nejmoa1500857
Abstract
The potential benefit of dual antiplatelet therapy beyond 1 year after a myocardial infarction has not been established. We investigated the efficacy and safety of ticagrelor, a P2Y12 receptor antagonist with established efficacy after an acute coronary syndrome, in this context. We randomly assigned, in a double-blind 1:1:1 fashion, 21,162 patients who had had a myocardial infarction 1 to 3 years earlier to ticagrelor at a dose of 90 mg twice daily, ticagrelor at a dose of 60 mg twice daily, or placebo. All the patients were to receive low-dose aspirin and were followed for a median of 33 months. The primary efficacy end point was the composite of cardiovascular death, myocardial infarction, or stroke. The primary safety end point was Thrombolysis in Myocardial Infarction (TIMI) major bleeding. The two ticagrelor doses each reduced, as compared with placebo, the rate of the primary efficacy end point, with Kaplan–Meier rates at 3 years of 7.85% in the group that received 90 mg of ticagrelor twice daily, 7.77% in the group that received 60 mg of ticagrelor twice daily, and 9.04% in the placebo group (hazard ratio for 90 mg of ticagrelor vs. placebo, 0.85; 95% confidence interval [CI], 0.75 to 0.96; P=0.008; hazard ratio for 60 mg of ticagrelor vs. placebo, 0.84; 95% CI, 0.74 to 0.95; P=0.004). Rates of TIMI major bleeding were higher with ticagrelor (2.60% with 90 mg and 2.30% with 60 mg) than with placebo (1.06%) (P<0.001 for each dose vs. placebo); the rates of intracranial hemorrhage or fatal bleeding in the three groups were 0.63%, 0.71%, and 0.60%, respectively. In patients with a myocardial infarction more than 1 year previously, treatment with ticagrelor significantly reduced the risk of cardiovascular death, myocardial infarction, or stroke and increased the risk of major bleeding. (Funded by AstraZeneca; PEGASUS-TIMI 54 ClinicalTrials.gov number, NCT01225562.)Keywords
This publication has 24 references indexed in Scilit:
- Heart Disease and Stroke Statistics—2015 UpdateCirculation, 2015
- 2014 AHA/ACC Guideline for the Management of Patients With Non–ST-Elevation Acute Coronary Syndromes: Executive SummaryCirculation, 2014
- Comparative Determinants of 4-Year Cardiovascular Event Rates in Stable Outpatients at Risk of or With AtherothrombosisJAMA, 2010
- Underestimated and under-recognized: the late consequences of acute coronary syndrome (GRACE UK-Belgian Study)European Heart Journal, 2010
- Ticagrelor versus Clopidogrel in Patients with Acute Coronary SyndromesThe New England Journal of Medicine, 2009
- Aspirin in the primary and secondary prevention of vascular disease: collaborative meta-analysis of individual participant data from randomised trialsThe Lancet, 2009
- Platelet Activation and AtherothrombosisThe New England Journal of Medicine, 2008
- Prasugrel versus Clopidogrel in Patients with Acute Coronary SyndromesThe New England Journal of Medicine, 2007
- Addition of Clopidogrel to Aspirin and Fibrinolytic Therapy for Myocardial Infarction with ST-Segment ElevationThe New England Journal of Medicine, 2005
- Effects of Clopidogrel in Addition to Aspirin in Patients with Acute Coronary Syndromes without ST-Segment ElevationThe New England Journal of Medicine, 2001