J 2016

Ticagrelor for Prevention of Ischemic Events After Myocardial Infarction in Patients With Peripheral Artery Disease

BONACA, M.P., D.L. BHATT, R.F. STOREY, G. STEG, M. COHEN et. al.

Základní údaje

Originální název

Ticagrelor for Prevention of Ischemic Events After Myocardial Infarction in Patients With Peripheral Artery Disease

Autoři

BONACA, M.P. (840 Spojené státy), D.L. BHATT (840 Spojené státy), R.F. STOREY (826 Velká Británie a Severní Irsko), G. STEG (250 Francie), M. COHEN (840 Spojené státy), J. KUDER (840 Spojené státy), E. GOODRICH (840 Spojené státy), J.C. NICOLAU (76 Brazílie), A. PARKHOMENKO (804 Ukrajina), J. LOPEZ-SENDON (724 Španělsko), M. DELLBORG (752 Švédsko), A. DALBY (710 Jižní Afrika), Jindřich ŠPINAR (203 Česká republika, garant, domácí), P. AYLWARD (36 Austrálie), R. CORBALAN (152 Chile), M.T.B. ABOLA (608 Filipíny), E.C. JENSEN (752 Švédsko), P. HELD (752 Švédsko), E. BRAUNWALD (840 Spojené státy) a M.S. SABATINE (840 Spojené státy)

Vydání

Journal of The American College of Cardiology, USA, Elsevier Science Inc. 2016, 0735-1097

Další údaje

Jazyk

angličtina

Typ výsledku

Článek v odborném periodiku

Obor

30201 Cardiac and Cardiovascular systems

Stát vydavatele

Spojené státy

Utajení

není předmětem státního či obchodního tajemství

Impakt faktor

Impact factor: 19.896

Kód RIV

RIV/00216224:14110/16:00090653

Organizační jednotka

Lékařská fakulta

DOI

UT WoS

000377274300003

Klíčová slova anglicky

acute limb ischemia; major adverse cardiovascular events; major adverse limb events; peripheral arterial disease; ticagrelor

Štítky

Příznaky

Mezinárodní význam, Recenzováno
Změněno: 29. 8. 2016 16:50, Soňa Böhmová

Anotace

V originále

BACKGROUND Peripheral artery disease (PAD) is associated with heightened ischemic and bleeding risk in patients with prior myocardial infarction (MI). OBJECTIVES This study evaluated the efficacy and safety of ticagrelor on major cardiovascular (CV) events and major adverse limb events in patients with PAD and a prior MI. METHODS 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) randomized 21,162 patients with prior MI (1 to 3 years) to ticagrelor 90 mg twice daily, ticagrelor 60 mg twice daily, or placebo, all on a background of low-dose aspirin. History of PAD was obtained at baseline. Occurrences of major adverse cardiovascular events (MACE) (defined as CV death, MI, or stroke) and major adverse limb events (MALE) (defined as acute limb ischemia or peripheral revascularization for ischemia) were recorded in follow-up. RESULTS A total of 1,143 patients (5%) had known PAD. In the placebo arm, those with PAD (n = 404) had higher rates of MACE at 3 years than those without (n = 6,663; 19.3% vs. 8.4%; p < 0.001), which persisted after adjusting for baseline differences (adjusted hazard ratio: 1.60; 95% confidence interval: 1.20 to 2.13; p = 0.0013), and higher rates of acute limb ischemia (1.0% vs. 0.1%) and peripheral revascularization procedures (9.15% vs. 0.46%). Whereas the relative risk reduction in MACE with ticagrelor was consistent, regardless of PAD, patients with PAD had a greater absolute risk reduction of 4.1% (number needed to treat: 25) due to their higher absolute risk. The absolute excess of TIMI major bleeding was 0.12% (number needed to harm: 834). The 60-mg dose had particularly favorable outcomes for CV and all-cause mortality. Ticagrelor (pooled doses) reduced the risk of MALE (hazard ratio: 0.65; 95% confidence interval: 0.44 to 0.95; p = 0.026).