Ticagrelor for Secondary Prevention of Atherothrombotic Events in Patients With Multivessel Coronary Disease

Sameer Bansilal, Marc P. Bonaca, Jan H. Cornel, Robert F. Storey, Deepak L. Bhatt, Ph Gabriel Steg, Kyungah Im, Sabina A. Murphy, Dominick J. Angiolillo, R. Kiss, Alexander N. Parkhomenko, Jose Lopez-Sendon, Daniel Isaza, Assen Goudev, Frederic Kontny, Peter Held, Eva C. Jensen, Eugene Braunwald, Marc S. Sabatine, A. J. Oude Ophuis

Research output: Article

20 Citations (Scopus)

Abstract

Background: Patients with prior myocardial infarction (MI) and multivessel coronary disease (MVD) are at high risk for recurrent coronary events. Objectives: The authors investigated the efficacy and safety of ticagrelor versus placebo in patients with MVD in the PEGASUS-TIMI 54 (Prevention of Cardiovascular Events in Patients With Prior Heart Attack Using Ticagrelor Compared to Placebo on a Background of Aspirin–Thrombolysis In Myocardial Infarction 54) trial. Methods: Patients with a history of MI 1 to 3 years before inclusion in the PEGASUS-TIMI 54 trial were stratified in a pre-specified analysis based on the presence of MVD. The effect of ticagrelor (60 mg and 90 mg) on the composite of cardiovascular death, MI, or stroke (major adverse cardiovascular events [MACE]), as well as the composite of coronary death, MI, or stent thrombosis (coronary events), and on TIMI major bleeding, intracranial hemorrhage (ICH), and fatal bleeding were evaluated over a median of 33 months. Results: A total of 12,558 patients (59.4%) had MVD. In the placebo arm, compared with patients without MVD, those with MVD were at higher risk for MACE (9.37% vs. 8.57%, adjusted hazard ratio [HRadj]: 1.24; p = 0.026) and for coronary events (7.67% vs. 5.34%, HRadj: 1.49; p = 0.0005). In patients with MVD, ticagrelor reduced the risk of MACE (7.94% vs. 9.37%, HR: 0.82; p = 0.004) and coronary events (6.02% vs. 7.67%, HR: 0.76; p < 0.0001), including a 36% reduction in coronary death (HR: 0.64; 95% confidence interval: 0.48 to 0.85; p = 0.002). In this subgroup, ticagrelor increased the risk of TIMI major bleeding (2.52% vs. 1.08%, HR: 2.67; p < 0.0001), but not ICH or fatal bleeds. Conclusions: Patients with prior MI and MVD are at increased risk of MACE and coronary events, and experience substantial relative and absolute risk reductions in both outcomes with long-term ticagrelor treatment relative to those without MVD. Ticagrelor increases the risk of TIMI major bleeding, but not ICH or fatal bleeding. For patients with prior MI and MVD, ticagrelor is an effective option for long-term antiplatelet therapy. (Prevention of Cardiovascular Events [e.g., 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 [PEGASUS]; NCT01225562)

Original languageEnglish
Pages (from-to)489-496
Number of pages8
JournalJournal of the American College of Cardiology
Volume71
Issue number5
DOIs
Publication statusPublished - febr. 6 2018

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Secondary Prevention
Coronary Disease
Myocardial Infarction
Intracranial Hemorrhages
Hemorrhage
Placebos
Stroke
Ticagrelor
Coronary Thrombosis
Numbers Needed To Treat
Vascular Diseases
Aspirin
Stents
Heart Diseases
Confidence Intervals
Safety
Therapeutics

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Bansilal, S., Bonaca, M. P., Cornel, J. H., Storey, R. F., Bhatt, D. L., Steg, P. G., ... Oude Ophuis, A. J. (2018). Ticagrelor for Secondary Prevention of Atherothrombotic Events in Patients With Multivessel Coronary Disease. Journal of the American College of Cardiology, 71(5), 489-496. https://doi.org/10.1016/j.jacc.2017.11.050

Ticagrelor for Secondary Prevention of Atherothrombotic Events in Patients With Multivessel Coronary Disease. / Bansilal, Sameer; Bonaca, Marc P.; Cornel, Jan H.; Storey, Robert F.; Bhatt, Deepak L.; Steg, Ph Gabriel; Im, Kyungah; Murphy, Sabina A.; Angiolillo, Dominick J.; Kiss, R.; Parkhomenko, Alexander N.; Lopez-Sendon, Jose; Isaza, Daniel; Goudev, Assen; Kontny, Frederic; Held, Peter; Jensen, Eva C.; Braunwald, Eugene; Sabatine, Marc S.; Oude Ophuis, A. J.

In: Journal of the American College of Cardiology, Vol. 71, No. 5, 06.02.2018, p. 489-496.

Research output: Article

Bansilal, S, Bonaca, MP, Cornel, JH, Storey, RF, Bhatt, DL, Steg, PG, Im, K, Murphy, SA, Angiolillo, DJ, Kiss, R, Parkhomenko, AN, Lopez-Sendon, J, Isaza, D, Goudev, A, Kontny, F, Held, P, Jensen, EC, Braunwald, E, Sabatine, MS & Oude Ophuis, AJ 2018, 'Ticagrelor for Secondary Prevention of Atherothrombotic Events in Patients With Multivessel Coronary Disease', Journal of the American College of Cardiology, vol. 71, no. 5, pp. 489-496. https://doi.org/10.1016/j.jacc.2017.11.050
Bansilal, Sameer ; Bonaca, Marc P. ; Cornel, Jan H. ; Storey, Robert F. ; Bhatt, Deepak L. ; Steg, Ph Gabriel ; Im, Kyungah ; Murphy, Sabina A. ; Angiolillo, Dominick J. ; Kiss, R. ; Parkhomenko, Alexander N. ; Lopez-Sendon, Jose ; Isaza, Daniel ; Goudev, Assen ; Kontny, Frederic ; Held, Peter ; Jensen, Eva C. ; Braunwald, Eugene ; Sabatine, Marc S. ; Oude Ophuis, A. J. / Ticagrelor for Secondary Prevention of Atherothrombotic Events in Patients With Multivessel Coronary Disease. In: Journal of the American College of Cardiology. 2018 ; Vol. 71, No. 5. pp. 489-496.
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author = "Sameer Bansilal and Bonaca, {Marc P.} and Cornel, {Jan H.} and Storey, {Robert F.} and Bhatt, {Deepak L.} and Steg, {Ph Gabriel} and Kyungah Im and Murphy, {Sabina A.} and Angiolillo, {Dominick J.} and R. Kiss and Parkhomenko, {Alexander N.} and Jose Lopez-Sendon and Daniel Isaza and Assen Goudev and Frederic Kontny and Peter Held and Jensen, {Eva C.} and Eugene Braunwald and Sabatine, {Marc S.} and {Oude Ophuis}, {A. J.}",
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TY - JOUR

T1 - Ticagrelor for Secondary Prevention of Atherothrombotic Events in Patients With Multivessel Coronary Disease

AU - Bansilal, Sameer

AU - Bonaca, Marc P.

AU - Cornel, Jan H.

AU - Storey, Robert F.

AU - Bhatt, Deepak L.

AU - Steg, Ph Gabriel

AU - Im, Kyungah

AU - Murphy, Sabina A.

AU - Angiolillo, Dominick J.

AU - Kiss, R.

AU - Parkhomenko, Alexander N.

AU - Lopez-Sendon, Jose

AU - Isaza, Daniel

AU - Goudev, Assen

AU - Kontny, Frederic

AU - Held, Peter

AU - Jensen, Eva C.

AU - Braunwald, Eugene

AU - Sabatine, Marc S.

AU - Oude Ophuis, A. J.

PY - 2018/2/6

Y1 - 2018/2/6

N2 - Background: Patients with prior myocardial infarction (MI) and multivessel coronary disease (MVD) are at high risk for recurrent coronary events. Objectives: The authors investigated the efficacy and safety of ticagrelor versus placebo in patients with MVD in the PEGASUS-TIMI 54 (Prevention of Cardiovascular Events in Patients With Prior Heart Attack Using Ticagrelor Compared to Placebo on a Background of Aspirin–Thrombolysis In Myocardial Infarction 54) trial. Methods: Patients with a history of MI 1 to 3 years before inclusion in the PEGASUS-TIMI 54 trial were stratified in a pre-specified analysis based on the presence of MVD. The effect of ticagrelor (60 mg and 90 mg) on the composite of cardiovascular death, MI, or stroke (major adverse cardiovascular events [MACE]), as well as the composite of coronary death, MI, or stent thrombosis (coronary events), and on TIMI major bleeding, intracranial hemorrhage (ICH), and fatal bleeding were evaluated over a median of 33 months. Results: A total of 12,558 patients (59.4%) had MVD. In the placebo arm, compared with patients without MVD, those with MVD were at higher risk for MACE (9.37% vs. 8.57%, adjusted hazard ratio [HRadj]: 1.24; p = 0.026) and for coronary events (7.67% vs. 5.34%, HRadj: 1.49; p = 0.0005). In patients with MVD, ticagrelor reduced the risk of MACE (7.94% vs. 9.37%, HR: 0.82; p = 0.004) and coronary events (6.02% vs. 7.67%, HR: 0.76; p < 0.0001), including a 36% reduction in coronary death (HR: 0.64; 95% confidence interval: 0.48 to 0.85; p = 0.002). In this subgroup, ticagrelor increased the risk of TIMI major bleeding (2.52% vs. 1.08%, HR: 2.67; p < 0.0001), but not ICH or fatal bleeds. Conclusions: Patients with prior MI and MVD are at increased risk of MACE and coronary events, and experience substantial relative and absolute risk reductions in both outcomes with long-term ticagrelor treatment relative to those without MVD. Ticagrelor increases the risk of TIMI major bleeding, but not ICH or fatal bleeding. For patients with prior MI and MVD, ticagrelor is an effective option for long-term antiplatelet therapy. (Prevention of Cardiovascular Events [e.g., 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 [PEGASUS]; NCT01225562)

AB - Background: Patients with prior myocardial infarction (MI) and multivessel coronary disease (MVD) are at high risk for recurrent coronary events. Objectives: The authors investigated the efficacy and safety of ticagrelor versus placebo in patients with MVD in the PEGASUS-TIMI 54 (Prevention of Cardiovascular Events in Patients With Prior Heart Attack Using Ticagrelor Compared to Placebo on a Background of Aspirin–Thrombolysis In Myocardial Infarction 54) trial. Methods: Patients with a history of MI 1 to 3 years before inclusion in the PEGASUS-TIMI 54 trial were stratified in a pre-specified analysis based on the presence of MVD. The effect of ticagrelor (60 mg and 90 mg) on the composite of cardiovascular death, MI, or stroke (major adverse cardiovascular events [MACE]), as well as the composite of coronary death, MI, or stent thrombosis (coronary events), and on TIMI major bleeding, intracranial hemorrhage (ICH), and fatal bleeding were evaluated over a median of 33 months. Results: A total of 12,558 patients (59.4%) had MVD. In the placebo arm, compared with patients without MVD, those with MVD were at higher risk for MACE (9.37% vs. 8.57%, adjusted hazard ratio [HRadj]: 1.24; p = 0.026) and for coronary events (7.67% vs. 5.34%, HRadj: 1.49; p = 0.0005). In patients with MVD, ticagrelor reduced the risk of MACE (7.94% vs. 9.37%, HR: 0.82; p = 0.004) and coronary events (6.02% vs. 7.67%, HR: 0.76; p < 0.0001), including a 36% reduction in coronary death (HR: 0.64; 95% confidence interval: 0.48 to 0.85; p = 0.002). In this subgroup, ticagrelor increased the risk of TIMI major bleeding (2.52% vs. 1.08%, HR: 2.67; p < 0.0001), but not ICH or fatal bleeds. Conclusions: Patients with prior MI and MVD are at increased risk of MACE and coronary events, and experience substantial relative and absolute risk reductions in both outcomes with long-term ticagrelor treatment relative to those without MVD. Ticagrelor increases the risk of TIMI major bleeding, but not ICH or fatal bleeding. For patients with prior MI and MVD, ticagrelor is an effective option for long-term antiplatelet therapy. (Prevention of Cardiovascular Events [e.g., 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 [PEGASUS]; NCT01225562)

KW - cardiovascular outcomes

KW - coronary disease

KW - platelet

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