Long-Term Ticagrelor in Patients With Prior Coronary Stenting in the PEGASUS-TIMI 54 Trial
| Autor: | KyungAh Im, Robert F. Storey, Marc P. Bonaca, Christian W. Hamm, Andrzej Budaj, Brian A. Bergmark, Róbert Gábor Kiss, Per Johanson, Julia F Kuder, Frans Van de Werf, Jindřich Špinar, Deepak L. Bhatt, Giulia Magnani, Eugene Braunwald, Ton Oude Ophuis, Marc S. Sabatine, Gilles Montalescot, Yared Gurmu, P. Gabriel Steg |
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| Přispěvatelé: | Harvard Medical School [Boston] (HMS), Laboratoire de Recherche Vasculaire Translationnelle (LVTS (UMR_S_1148 / U1148)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Paris (UP)-Université Sorbonne Paris Nord, National Heart and Lung Institute [London] (NHLI), Imperial College London-Royal Brompton and Harefield NHS Foundation Trust, Medical Center of Postgraduate Education [Warsaw] (MCPE), University of Sheffield [Sheffield], University Hospital of Parma [Parme, Italie], Canisius-Wilhelmina Hospital [Nijmegen, The Netherlands], Universität Giessen [Germany], St. Anne’s University Hospital [Brno], University Hospitals Leuven [Leuven], Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Institute of cardiometabolism and nutrition (ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), AstraZeneca, University of Colorado Anschutz [Aurora] |
| Rok vydání: | 2021 |
| Předmět: |
Ticagrelor
Cardiac & Cardiovascular Systems medicine.medical_treatment Myocardial Infarction Coronary Artery Disease SECONDARY PREVENTION 030204 cardiovascular system & hematology antiplatelet therapy PRIOR MYOCARDIAL-INFARCTION 0302 clinical medicine Clinical Studies Secondary Prevention Stent Coronary Heart Disease 030212 general & internal medicine Stent thrombosis Original Research DUAL ANTIPLATELET THERAPY Coronary stenting Drug-Eluting Stents PCI 3. Good health Stroke Treatment Outcome CLOPIDOGREL Cardiology Drug Therapy Combination Stents Cardiology and Cardiovascular Medicine Life Sciences & Biomedicine TIMI medicine.drug Acute coronary syndrome medicine.medical_specialty Hemorrhage P2Y12 inhibitor acute coronary syndrome 03 medical and health sciences ATHEROTHROMBOTIC RISK STRATIFICATION Percutaneous Coronary Intervention INFLAMMATION [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system Internal medicine Coronary stent medicine Diseases of the circulatory (Cardiovascular) system Humans In patient cardiovascular diseases P2Y(12) inhibitor Pharmacology Science & Technology business.industry RIVAROXABAN Thrombosis medicine.disease equipment and supplies ASPIRIN ATHEROSCLEROSIS RC666-701 Conventional PCI Cardiovascular System & Cardiology VORAPAXAR business Platelet Aggregation Inhibitors |
| Zdroj: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, Vol 10, Iss 17 (2021) Journal of the American Heart Association Journal of the American Heart Association, Wiley-Blackwell, 2021, 10 (17), ⟨10.1161/JAHA.120.020446⟩ |
| ISSN: | 2047-9980 |
| Popis: | Background Coronary stent type and risk of stent thrombosis remain important factors affecting recommended duration of dual antiplatelet therapy. We investigated the efficacy and safety of long‐term ticagrelor in patients with prior coronary stenting enrolled in the PEGASUS‐TIMI 54 (Prevention of Cardiovascular Events in Patients with Prior Heart Attack Using Ticagrelor Compared to Placebo on a Background of Aspirin–Thrombolysis in Myocardial Infarction 54) trial. Methods and Results Patients in PEGASUS‐TIMI 54 had a myocardial infarction 1 to 3 year prior and were randomized 1:1:1 to ticagrelor 60 or 90 mg BID or placebo. The primary end point was a composite of cardiovascular death, myocardial infarction, or stroke (major adverse cardiovascular events). Stent thrombosis was prospectively adjudicated (Academic Research Consortium definition). Baseline characteristics were compared by most recent stent type (bare metal versus drug‐eluting stent and first‐ versus later‐generation drug‐eluting stent). Treatment arms were compared using Cox proportional hazards models. Of 21 162 patients randomized, 80% (n=16 891) had prior coronary stenting. Following randomization, myocardial infarction was the most frequent ischemic event in patients with prior stenting in the placebo arm, occurring in 5.2% of patients (Type 1: 4.1%), followed by cardiovascular death (2.3%), stroke (1.7%), and stent thrombosis (0.9%). Ticagrelor pooled reduced major adverse cardiovascular events (7.0% versus 8.0%; hazard ratio [HR], 0.85; 95% CI, 0.75–96) regardless of stent type (bare metal stent versus drug‐eluting stent: p interaction =0.767; first versus later generation: p interaction =0.940). The rate of any stent thrombosis was numerically lower with ticagrelor pooled (0.7% versus 0.9%; HR, 0.73; 95% CI, 0.50–1.05) and Thrombolysis in Myocardial Infarction major bleeding was increased (HR, 2.65; 95% CI, 1.90–3.68). Conclusions Long‐term ticagrelor reduces major adverse cardiovascular events in patients with prior myocardial infarction and coronary stenting regardless of stent type, with the benefit driven predominantly by reduction in de novo events. Nonfatal major bleeding is increased with ticagrelor. Registration Information clinicaltrials.gov. Identifier: NCT01225562. |
| Databáze: | OpenAIRE |
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