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Long-term use of ticagrelor in patients with prior myocardial infarction.
- Source :
-
The New England journal of medicine [N Engl J Med] 2015 May 07; Vol. 372 (19), pp. 1791-800. Date of Electronic Publication: 2015 Mar 14. - Publication Year :
- 2015
-
Abstract
- Background: 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.<br />Methods: 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.<br />Results: 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.<br />Conclusions: 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.).
- Subjects :
- Adenosine administration & dosage
Adenosine adverse effects
Aged
Aspirin administration & dosage
Cardiovascular Diseases mortality
Cardiovascular Diseases prevention & control
Double-Blind Method
Drug Administration Schedule
Drug Therapy, Combination
Female
Hemorrhage chemically induced
Humans
Intracranial Hemorrhages chemically induced
Kaplan-Meier Estimate
Male
Middle Aged
Platelet Aggregation Inhibitors adverse effects
Purinergic P2Y Receptor Antagonists administration & dosage
Purinergic P2Y Receptor Antagonists adverse effects
Risk
Secondary Prevention
Ticagrelor
Adenosine analogs & derivatives
Myocardial Infarction drug therapy
Platelet Aggregation Inhibitors administration & dosage
Subjects
Details
- Language :
- English
- ISSN :
- 1533-4406
- Volume :
- 372
- Issue :
- 19
- Database :
- MEDLINE
- Journal :
- The New England journal of medicine
- Publication Type :
- Academic Journal
- Accession number :
- 25773268
- Full Text :
- https://doi.org/10.1056/NEJMoa1500857