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@article{1352672,
author = {Bonaca, M.P. and Bhatt, D.L. and Storey, R.F. and Steg, G. and Cohen, M. and Kuder, J. and Goodrich, E. and Nicolau, J.C. and Parkhomenko, A. and LopezandSendon, J. and Dellborg, M. and Dalby, A. and Špinar, Jindřich and Aylward, P. and Corbalan, R. and Abola, M.T.B. and Jensen, E.C. and Held, P. and Braunwald, E. and Sabatine, M.S.},
article_location = {USA},
article_number = {23},
doi = {http://dx.doi.org/10.1016/j.jacc.2016.03.524},
keywords = {acute limb ischemia; major adverse cardiovascular events; major adverse limb events; peripheral arterial disease; ticagrelor},
language = {eng},
issn = {0735-1097},
journal = {Journal of The American College of Cardiology},
title = {Ticagrelor for Prevention of Ischemic Events After Myocardial Infarction in Patients With Peripheral Artery Disease},
volume = {67},
year = {2016}
}
TY - JOUR
ID - 1352672
AU - Bonaca, M.P. - Bhatt, D.L. - Storey, R.F. - Steg, G. - Cohen, M. - Kuder, J. - Goodrich, E. - Nicolau, J.C. - Parkhomenko, A. - Lopez-Sendon, J. - Dellborg, M. - Dalby, A. - Špinar, Jindřich - Aylward, P. - Corbalan, R. - Abola, M.T.B. - Jensen, E.C. - Held, P. - Braunwald, E. - Sabatine, M.S.
PY - 2016
TI - Ticagrelor for Prevention of Ischemic Events After Myocardial Infarction in Patients With Peripheral Artery Disease
JF - Journal of The American College of Cardiology
VL - 67
IS - 23
SP - 2719-2728
EP - 2719-2728
PB - Elsevier Science Inc.
SN - 07351097
KW - acute limb ischemia
KW - major adverse cardiovascular events
KW - major adverse limb events
KW - peripheral arterial disease
KW - ticagrelor
N2 - 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).
ER -
BONACA, M.P., D.L. BHATT, R.F. STOREY, G. STEG, M. COHEN, J. KUDER, E. GOODRICH, J.C. NICOLAU, A. PARKHOMENKO, J. LOPEZ-SENDON, M. DELLBORG, A. DALBY, Jindřich ŠPINAR, P. AYLWARD, R. CORBALAN, M.T.B. ABOLA, E.C. JENSEN, P. HELD, E. BRAUNWALD a M.S. SABATINE. Ticagrelor for Prevention of Ischemic Events After Myocardial Infarction in Patients With Peripheral Artery Disease. \textit{Journal of The American College of Cardiology}. USA: Elsevier Science Inc., 2016, roč.~67, č.~23, s.~2719-2728. ISSN~0735-1097. Dostupné z: https://dx.doi.org/10.1016/j.jacc.2016.03.524.
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