Prevention of Stroke with Ticagrelor in Patients with Prior
Myocardial Infarction Insights from 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)

J 2016

Prevention of Stroke with Ticagrelor in Patients with Prior Myocardial Infarction Insights from 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)

BONACA, Marc P.; Shinya GOTO; Deepak L. BHATT; P. Gabriel STEG; Robert F. STOREY et al.

Základní údaje

Originální název

Prevention of Stroke with Ticagrelor in Patients with Prior Myocardial Infarction Insights from 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)

Autoři

Vydání

Circulation, Philadelphia, Lippincott Williams and Wilkins, 2016, 0009-7322

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: 19.309

Označené pro přenos do RIV

Ano

Kód RIV

RIV/00216224:14110/16:00092730

Organizační jednotka

Lékařská fakulta

Klíčová slova anglicky

hemorrhagic stroke; ischemic stroke; platelet aggregation inhibitors; secondary prevention; stroke; thrombosis; ticagrelor

Štítky

EL OK

Příznaky

Mezinárodní význam, Recenzováno

Změněno: 12. 4. 2018 16:57, Soňa Böhmová

Anotace

V originále

BACKGROUND: In the PEGASUS-TIMI 54 trial (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), ticagrelor reduced the risk of major adverse cardiovascular events when added to low-dose aspirin in stable patients with prior myocardial infarction, resulting in the approval of ticagrelor 60 mg twice daily for long-term secondary prevention. We investigated the incidence of stroke, outcomes after stroke, and the efficacy of ticagrelor focusing on the approved 60 mg twice daily dose for reducing stroke in this population. METHODS: Patients were followed for a median of 33 months. Stroke events were adjudicated by a central committee. Data from similar trials were combined using meta-analysis. RESULTS: Of 14 112 patients randomly assigned to placebo or ticagrelor 60 mg, 213 experienced a stroke; 85% of these strokes were ischemic. A total of 18% of strokes were fatal and another 15% led to either moderate or severe disability at 30 days. Ticagrelor significantly reduced the risk of stroke (hazard ratio, 0.75; 95% confidence interval, 0.57-0.98; P=0.034), driven by a reduction in ischemic stroke (hazard ratio, 0.76; 95% confidence interval, 0.56-1.02). Hemorrhagic stroke occurred in 9 patients on placebo and 8 patients on ticagrelor. A meta-analysis across 4 placebo-controlled trials of more intensive antiplatelet therapy in 44 816 patients with coronary disease confirmed a marked reduction in ischemic stroke (hazard ratio, 0.66; 95% confidence interval, 0.54-0.81; P=0.0001). CONCLUSIONS: High-risk patients with prior myocardial infarction are at risk for stroke, approximately one-third of which are fatal or lead to moderate-to-severe disability. The addition of ticagrelor 60 mg twice daily significantly reduced this risk without an excess of hemorrhagic stroke but with more major bleeding. In high-risk patients with coronary disease, more intensive antiplatelet therapy should be considered not only to reduce the risk of coronary events, but also of stroke.

Citovat

BONACA, Marc P.; Shinya GOTO; Deepak L. BHATT; P. Gabriel STEG; Robert F. STOREY; Marc COHEN; Erica GOODRICH; Laura MAURI; Ton Oude OPHUIS; Mikhail RUDA; Jindřich ŠPINAR; Ki-Bae SEUNG; Dayi HU; Anthony J. DALBY; Eva JENSEN; Peter HELD; David A. MORROW; Eugene BRAUNWALD a Marc S. SABATINE. Prevention of Stroke with Ticagrelor in Patients with Prior Myocardial Infarction Insights from 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). Circulation. Philadelphia: Lippincott Williams and Wilkins, 2016, roč. 134, č. 12, s. "861"-"+", 21 s. ISSN 0009-7322. Dostupné z: https://doi.org/10.1161/CIRCULATIONAHA.116.024637.

@article{1367150,
   author = {Bonaca, Marc P. and Goto, Shinya and Bhatt, Deepak L. and Steg, P. Gabriel and Storey, Robert F. and Cohen, Marc and Goodrich, Erica and Mauri, Laura and Ophuis, Ton Oude and Ruda, Mikhail and Špinar, Jindřich and Seung, KiandBae and Hu, Dayi and Dalby, Anthony J. and Jensen, Eva and Held, Peter and Morrow, David A. and Braunwald, Eugene and Sabatine, Marc S.},
   article_location = {Philadelphia},
   article_number = {12},
   doi = {https://doi.org/10.1161/CIRCULATIONAHA.116.024637},
   keywords = {hemorrhagic stroke; ischemic stroke; platelet aggregation inhibitors; secondary prevention; stroke; thrombosis; ticagrelor},
   language = {eng},
   issn = {0009-7322},
   journal = {Circulation},
   title = {Prevention of Stroke with Ticagrelor in Patients with Prior Myocardial Infarction Insights from 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)},
   volume = {134},
   year = {2016}
}

TY  - JOUR
ID  - 1367150
AU  - Bonaca, Marc P. - Goto, Shinya - Bhatt, Deepak L. - Steg, P. Gabriel - Storey, Robert F. - Cohen, Marc - Goodrich, Erica - Mauri, Laura - Ophuis, Ton Oude - Ruda, Mikhail - Špinar, Jindřich - Seung, Ki-Bae - Hu, Dayi - Dalby, Anthony J. - Jensen, Eva - Held, Peter - Morrow, David A. - Braunwald, Eugene - Sabatine, Marc S.
PY  - 2016
TI  - Prevention of Stroke with Ticagrelor in Patients with Prior Myocardial Infarction Insights from 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)
JF  - Circulation
VL  - 134
IS  - 12
SP  - "861"-"+"
EP  - "861"-"+"
PB  - Lippincott Williams and Wilkins
SN  - 00097322
KW  - hemorrhagic stroke
KW  - ischemic stroke
KW  - platelet aggregation inhibitors
KW  - secondary prevention
KW  - stroke
KW  - thrombosis
KW  - ticagrelor
N2  - BACKGROUND: In the PEGASUS-TIMI 54 trial (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), ticagrelor reduced the risk of major adverse cardiovascular events when added to low-dose aspirin in stable patients with prior myocardial infarction, resulting in the approval of ticagrelor 60 mg twice daily for long-term secondary prevention. We investigated the incidence of stroke, outcomes after stroke, and the efficacy of ticagrelor focusing on the approved 60 mg twice daily dose for reducing stroke in this population. METHODS: Patients were followed for a median of 33 months. Stroke events were adjudicated by a central committee. Data from similar trials were combined using meta-analysis. RESULTS: Of 14 112 patients randomly assigned to placebo or ticagrelor 60 mg, 213 experienced a stroke; 85% of these strokes were ischemic. A total of 18% of strokes were fatal and another 15% led to either moderate or severe disability at 30 days. Ticagrelor significantly reduced the risk of stroke (hazard ratio, 0.75; 95% confidence interval, 0.57-0.98; P=0.034), driven by a reduction in ischemic stroke (hazard ratio, 0.76; 95% confidence interval, 0.56-1.02). Hemorrhagic stroke occurred in 9 patients on placebo and 8 patients on ticagrelor. A meta-analysis across 4 placebo-controlled trials of more intensive antiplatelet therapy in 44 816 patients with coronary disease confirmed a marked reduction in ischemic stroke (hazard ratio, 0.66; 95% confidence interval, 0.54-0.81; P=0.0001). CONCLUSIONS: High-risk patients with prior myocardial infarction are at risk for stroke, approximately one-third of which are fatal or lead to moderate-to-severe disability. The addition of ticagrelor 60 mg twice daily significantly reduced this risk without an excess of hemorrhagic stroke but with more major bleeding. In high-risk patients with coronary disease, more intensive antiplatelet therapy should be considered not only to reduce the risk of coronary events, but also of stroke.
ER  -

BONACA, Marc P.; Shinya GOTO; Deepak L. BHATT; P. Gabriel STEG; Robert F. STOREY; Marc COHEN; Erica GOODRICH; Laura MAURI; Ton Oude OPHUIS; Mikhail RUDA; Jindřich ŠPINAR; Ki-Bae SEUNG; Dayi HU; Anthony J. DALBY; Eva JENSEN; Peter HELD; David A. MORROW; Eugene BRAUNWALD a Marc S. SABATINE. Prevention of Stroke with Ticagrelor in Patients with Prior Myocardial Infarction Insights from 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). \textit{Circulation}. Philadelphia: Lippincott Williams and Wilkins, 2016, roč.~134, č.~12, s.~''861''-''+'', 21 s. ISSN~0009-7322. Dostupné z: https://doi.org/10.1161/CIRCULATIONAHA.116.024637.

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