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Reduction in Subtypes and Sizes of Myocardial Infarction With Ticagrelor in PEGASUS-TIMI 54.

  • Bonaca MP 1 TIMI Study Group Brigham and Women's Hospital Boston MA.
  • Wiviott SD 1 TIMI Study Group Brigham and Women's Hospital Boston MA.
  • Morrow DA 1 TIMI Study Group Brigham and Women's Hospital Boston MA.
  • Steg PG 2 FACT, DHU FIRE Hôpital Bichat Assistance Publique-Hôpitaux de Paris Paris France.
  • Hamm C 3 Department of Medicine Kerckhoff Heart Center BadNauheim Germany.
  • Bhatt DL 1 TIMI Study Group Brigham and Women's Hospital Boston MA.
  • Storey RF 4 Department of Medicine University of Sheffield United Kingdom.
  • Cohen M 5 Newark Beth Israel Medical Center Rutgers-New Jersey Medical School Newark NJ.
  • Kuder J 1 TIMI Study Group Brigham and Women's Hospital Boston MA.
  • Im K 1 TIMI Study Group Brigham and Women's Hospital Boston MA.
  • Magnani G 6 UniversitätsSpital Zürich (USZ) & Zürich Heart House ‎University Hospital of Zurich Switzerland.
  • Budaj A 7 Postgraduate Medical School Grochowski Hospital Warsaw Poland.
  • Nicolau JC 8 Heart Institute (InCor) University of São Paulo Medical School São Paulo Brazil.
  • Parkhomenko A 9 Department of Medicine Institute of Cardiology Kiev Ukraine.
  • López-Sendón J 10 Department of Medicine Hosp Univrio La Paz Madrid Spain.
  • Dellborg M 11 Sahlgrenska Acad University of Gothenburg Sweden.
  • Diaz R 12 Department of Medicine ECLA (Estudios Clínicos Latino América) Rosario Argentina.
  • Van de Werf F 13 Department of Medicine University of Leuven Belgium.
  • Corbalán R 14 Department of Medicine Pontificia Univ Catolica de Chile Santiago Chile.
  • Goudev A 15 Medical University of Sofia Queen Ioanna University Hospital Sofia Bulgaria.
  • Jensen EC 16 AstraZeneca Mölndal Sweden.
  • Johanson P 16 AstraZeneca Mölndal Sweden.
  • Braunwald E 1 TIMI Study Group Brigham and Women's Hospital Boston MA.
  • Sabatine MS 1 TIMI Study Group Brigham and Women's Hospital Boston MA.
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  • 2018-12-21
Published in:
  • Journal of the American Heart Association. - 2018
ST‐segment elevation myocardial infarction
antiplatelet therapy
myocardial infarction
ticagrelor
troponin
Aged
Death, Sudden, Cardiac
Humans
Middle Aged
Myocardial Infarction
Platelet Aggregation Inhibitors
ST Elevation Myocardial Infarction
Ticagrelor
English Background Ticagrelor reduced cardiovascular death, myocardial infarction (MI), or stroke in patients with prior MI in PEGASUS-TIMI 54 (Prevention of Cardiovascular Events [eg, Death From Heart or Vascular Disease, Heart Attack, or Stroke] in Patients With Prior Heart Attack Using Ticagrelor Compared to Placebo on a Background of Aspirin). MI can occur in diverse settings and with varying severity; therefore, understanding the types and sizes of MI events prevented is of clinical importance. Methods and Results MIs were adjudicated by a blinded clinical events committee and categorized by subtype and fold elevation of peak cardiac troponin over the upper limit of normal. A total of 1042 MIs occurred in 898 of the 21 162 randomized patients over a median follow-up of 33 months. The majority of the MIs (76%) were spontaneous (Type 1), with demand MI (Type 2) and stent thrombosis (Type 4b) accounting for 13% and 9%, respectively; sudden death (Type 3), percutaneous coronary intervention-related (Type 4a) and coronary artery bypass graft-related (Type 5) each accounted for <1%. Half of MIs (520, 50%) had a peak troponin ≥10x upper limit of normal and 21% of MIs (220) had a peak troponin ≥100× upper limit of normal. A total of 21% (224) were ST-segment-elevation MI STEMI. Overall ticagrelor reduced MI (4.47% versus 5.25%, hazard ratio 0.83, 95% confidence interval 0.72-0.95, P=0.0055). The benefit was consistent among the subtypes, including a 31% reduction in MIs with a peak troponin ≥100× upper limit of normal (hazard ratio 0.69, 95% confidence interval 0.53-0.92, P=0.0096) and a 40% reduction in ST-segment elevation MI (hazard ratio 0.60, 95% confidence interval 0.46-0.78, P=0.0002). Conclusions In stable outpatients with prior MI, the majority of recurrent MIs are spontaneous and associated with a high biomarker elevation. Ticagrelor reduces the MI consistently among subtypes and sizes including large MIs and ST-segment elevation MI. Clinical Trial Registration URL: https://www.clinicaltrials.gov . Unique identifier: NCT01225562.
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  • English
Open access status
gold
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https://sonar.ch/global/documents/191481
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