In:
Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 132, No. suppl_3 ( 2015-11-10)
Abstract:
Objectives: Ticagrelor reduced the risk of CV death, MI or stroke in stable patients with prior MI in PEGASUS-TIMI 54. We investigated the consistency of ticagrelor’s efficacy and safety over time and quantified the magnitude of benefit in patients who tolerated ticagrelor for the first year, analogous to the clinical situation of extending therapy in patients after 1 year. Methods: PEGASUS-TIMI 54 randomized pts with a prior MI (median 1.7 yrs prior to randomization) to ticagrelor 90 mg twice daily, ticagrelor 60 mg twice daily or placebo. The rate CVD/MI/stroke and TIMI major bleeding were analyzed for the pooled ticagrelor doses compared to placebo for the first year of observation and then as a landmark analysis beginning after the first year in all patients alive at that time point. Results: 21,162 patients were randomized and followed for a median of 33 months, with 29% of patients ≥5 yrs from their most recent MI by the end of the trial. The rate of CVD/MI/stroke in the placebo arm remained roughly constant over the trial at ∼3%/y. Ticagrelor significantly reduced CVD/MI/stroke both over the first year (HR 0.84, 95% CI 0.71-0.98, P=0.029, Figure Left) and after year one (HR 0.85, 95% CI 0.74-0.97, P=0.017, Figure Right), with the event curves continuing to diverge through the end of follow-up. TIMI Major bleeding was increased with ticagrelor within the first year (HR 3.46, 95% CI 2.07-5.77) but numerically less so after the first year (HR 2.06, 95% CI 1.43-2.96). When examining patients who successfully completed one year of treatment, continued ticagrelor significantly reduced CVD/MI/Stroke by over 20% over the following two years (HR 0.79, 95% CI 0.68-0.91). Conclusion: Patients with a history of MI remain at persistent risk for CVD/MI/Stroke over time. Ticagrelor reduces this risk during the first year as well as in the subsequent years of treatment, supporting prolonged therapy.
Type of Medium:
Online Resource
ISSN:
0009-7322
,
1524-4539
DOI:
10.1161/circ.132.suppl_3.19642
Language:
English
Publisher:
Ovid Technologies (Wolters Kluwer Health)
Publication Date:
2015
detail.hit.zdb_id:
1466401-X
