Remo H M Furtado1,2, Jose C Nicolau2, Giulia Magnani3, Kyungah Im1, Deepak L Bhatt1, Robert F Storey4, P Gabriel Steg5, Jindrich Spinar6, Andrzej Budaj7, Frederic Kontny8,9, Ramon Corbalan10, Robert G Kiss11, Maria Teresa Abola12, Per Johanson13, Eva C Jensen13, Eugene Braunwald1, Marc S Sabatine1, Marc P Bonaca1,14. 1. TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, USA. 2. Instituto do Coracao (InCor), Hospital das Clinicas da Faculdade de Medicina, Universidade de Sao Paulo, Av Dr Eneas de Carvalho Aguiar 44, 05403 Sao Paulo, Brazil. 3. University Hospital of Parma, Via Gramsci, 14, 43126 Parma PR, Italy. 4. University of Sheffield, Western Bank, Sheffield S10 2TN, UK. 5. Assistance Publique-Hôpitaux de Paris, 3 Avenue Victoria, 75004 Paris, France. 6. University Hospital Brno, 20 Jihlavska, Brno, Czech Republic. 7. Centre of Postgraduate Medical Education, Grochowski Hospital, Grenadierów 51/59, 04-073 Warsaw, Poland. 8. Department of Cardiology, Stavanger University Hospital, Gerd Ragna Bloch Thorsens gate 8, Stavanger, Norway. 9. Drammen Heart Center, Dronninggata 28, 3004 Drammen, Norway. 10. Cardiovascular Division, Faculty of Medicine, Pontificia Universidad Católica de Chile, Lira 40, Santiago, Chile. 11. Department of Cardiology, Military Hospital, Róbert Károly krt., 1134 Budapest, Hungary. 12. College of Medicine, University of the Philippines/Philippine Heart Center, East, Quezon City, Metro Manila, Philippines. 13. AstraZeneca, 431 53 Mölndal, Sweden. 14. CPC Clinical Research, University of Colorado School of Medicine, 13199 E Montview Blvd Suite 200, Aurora, CO, USA.
Abstract
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. Published on behalf of the European Society of Cardiology. All rights reserved.
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. Published on behalf of the European Society of Cardiology. All rights reserved.
Authors: Jacek Kubica; Piotr Adamski; Piotr Niezgoda; Dimitrios Alexopoulos; Jolita Badarienė; Andrzej Budaj; Katarzyna Buszko; Dariusz Dudek; Tomasz Fabiszak; Mariusz Gąsior; Robert Gil; Diana A Gorog; Stefan Grajek; Paul A Gurbel; Marcin Gruchała; Miłosz J Jaguszewski; Stefan James; Young-Hoon Jeong; Bernd Jilma; Jarosław D Kasprzak; Andrzej Kleinrok; Aldona Kubica; Wiktor Kuliczkowski; Jacek Legutko; Maciej Lesiak; Jolanta M Siller-Matula; Klaudiusz Nadolny; Krzysztof Pstrągowski; Salvatore Di Somma; Giuseppe Specchia; Janina Stępińska; Udaya S Tantry; Agnieszka Tycińska; Monica Verdoia; Wojciech Wojakowski; Eliano P Navarese Journal: Cardiol J Date: 2020-10-19 Impact factor: 2.737
Authors: José Carlos Nicolau; Gilson Soares Feitosa Filho; João Luiz Petriz; Remo Holanda de Mendonça Furtado; Dalton Bertolim Précoma; Walmor Lemke; Renato Delascio Lopes; Ari Timerman; José A Marin Neto; Luiz Bezerra Neto; Bruno Ferraz de Oliveira Gomes; Eduardo Cavalcanti Lapa Santos; Leopoldo Soares Piegas; Alexandre de Matos Soeiro; Alexandre Jorge de Andrade Negri; Andre Franci; Brivaldo Markman Filho; Bruno Mendonça Baccaro; Carlos Eduardo Lucena Montenegro; Carlos Eduardo Rochitte; Carlos José Dornas Gonçalves Barbosa; Cláudio Marcelo Bittencourt das Virgens; Edson Stefanini; Euler Roberto Fernandes Manenti; Felipe Gallego Lima; Francisco das Chagas Monteiro Júnior; Harry Correa Filho; Henrique Patrus Mundim Pena; Ibraim Masciarelli Francisco Pinto; João Luiz de Alencar Araripe Falcão; Joberto Pinheiro Sena; José Maria Peixoto; Juliana Ascenção de Souza; Leonardo Sara da Silva; Lilia Nigro Maia; Louis Nakayama Ohe; Luciano Moreira Baracioli; Luís Alberto de Oliveira Dallan; Luis Augusto Palma Dallan; Luiz Alberto Piva E Mattos; Luiz Carlos Bodanese; Luiz Eduardo Fonteles Ritt; Manoel Fernandes Canesin; Marcelo Bueno da Silva Rivas; Marcelo Franken; Marcos José Gomes Magalhães; Múcio Tavares de Oliveira Júnior; Nivaldo Menezes Filgueiras Filho; Oscar Pereira Dutra; Otávio Rizzi Coelho; Paulo Ernesto Leães; Paulo Roberto Ferreira Rossi; Paulo Rogério Soares; Pedro Alves Lemos Neto; Pedro Silvio Farsky; Rafael Rebêlo C Cavalcanti; Renato Jorge Alves; Renato Abdala Karam Kalil; Roberto Esporcatte; Roberto Luiz Marino; Roberto Rocha Corrêa Veiga Giraldez; Romeu Sérgio Meneghelo; Ronaldo de Souza Leão Lima; Rui Fernando Ramos; Sandra Nivea Dos Reis Saraiva Falcão; Talia Falcão Dalçóquio; Viviana de Mello Guzzo Lemke; William Azem Chalela; Wilson Mathias Júnior Journal: Arq Bras Cardiol Date: 2021-07 Impact factor: 2.667
Authors: Dario Tino Bertolone; Emanuele Gallinoro; Giuseppe Esposito; Pasquale Paolisso; Konstantinos Bermpeis; Cristina De Colle; Davide Fabbricatore; Niya Mileva; Chiara Valeriano; Daniel Munhoz; Marta Belmonte; Marc Vanderheyden; Jozef Bartunek; Jeroen Sonck; Eric Wyffels; Carlos Collet; Costantino Mancusi; Carmine Morisco; Nicola De Luca; Bernard De Bruyne; Emanuele Barbato Journal: High Blood Press Cardiovasc Prev Date: 2022-02-11
Authors: Brian A Bergmark; Deepak L Bhatt; P Gabriel Steg; Andrzej Budaj; Robert F Storey; Yared Gurmu; Julia F Kuder; KyungAh Im; Giulia Magnani; Ton Oude Ophuis; Christian Hamm; Jindřich Špinar; Robert G Kiss; Frans J Van de Werf; Gilles Montalescot; Per Johanson; Eugene Braunwald; Marc S Sabatine; Marc P Bonaca Journal: J Am Heart Assoc Date: 2021-08-21 Impact factor: 5.501