In:
Journal of the American Heart Association, Ovid Technologies (Wolters Kluwer Health), Vol. 5, No. 7 ( 2016-07-06)
Abstract:
Our dual aims were as follows: (1) to classify new or recurrent myocardial infarctions ( MI ) in patients with stable atherosclerosis using the Universal Definition of MI classification system; and (2) to characterize the effects of vorapaxar, a first‐in‐class platelet protease‐activated receptor ‐1 antagonist, on new or recurrent MI . Methods and Results We analyzed data from TRA 2°P‐ TIMI 50, a multinational, randomized, double‐blind, placebo‐controlled trial of vorapaxar. This analysis included 20 770 patients with previous MI or peripheral arterial disease without a history of transient ischemic attack or stroke. Each new or recurrent MI after randomization that met the trial end point definition was further categorized according to the European Society of Cardiology, American College of Cardiology, American Heart Association, World Heart Federation Universal Definition classification of type and size. Of 1095 incident MI s, 77% were spontaneous (Type 1), with a smaller number (9.8%) of secondary MI s (Type 2). Vorapaxar reduced Type 1 MI (hazard ratio [ HR ] 0.84, CI 0.73–0.98, P =0.024), with a similar pattern for Type 2 MI ( HR 0.74, CI 0.49–1.10, P =0.13). Notably, vorapaxar showed a consistent pattern of reduction across size of MI s, including MI s in the highest Universal MI size class (≥10× upper reference limit, HR 0.83, CI 0.70–0.98, P =0.025). As such, there was a significant reduction in larger, spontaneous MI s (Type 1, ≥10× upper reference limit, HR 0.81, CI 0.67–0.99, P =0.036), and a consistent pattern with respect to fatal MI ( HR 0.66, CI 0.39–1.11, P =0.12). Conclusions Among stable patients with established atherosclerosis, the most common type of incident MI is spontaneous MI , and the reduction in MI with vorapaxar was consistent across MI s of varying type and size, including spontaneous infarctions ≥10× upper reference limit. Clinical Trial Registration URL : https://www.clinicaltrials.gov . Unique identifier: NCT 00526474.
Type of Medium:
Online Resource
ISSN:
2047-9980
DOI:
10.1161/JAHA.116.003237
Language:
English
Publisher:
Ovid Technologies (Wolters Kluwer Health)
Publication Date:
2016
detail.hit.zdb_id:
2653953-6
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