Long-Term Ticagrelor in Patients With Prior Coronary Stenting
in the PEGASUS-TIMI 54 Trial

J 2021

Long-Term Ticagrelor in Patients With Prior Coronary Stenting in the PEGASUS-TIMI 54 Trial

BERGMARK, B. A., D. L. BHATT, P. G. STEG, A. BUDAJ, R. F. STOREY et. al.

Basic information

Original name

Long-Term Ticagrelor in Patients With Prior Coronary Stenting in the PEGASUS-TIMI 54 Trial

Authors

BERGMARK, B. A. (guarantor), D. L. BHATT, P. G. STEG, A. BUDAJ, R. F. STOREY, Y. GURMU, J. F. KUDER, K. IM, G. MAGNANI, T. O. OPHUIS, C. HAMM, Jindřich ŠPINAR (203 Czech Republic, belonging to the institution), R. G. KISS, F. J. VAN DE WERF, G. MONTALESCOT, P. JOHANSON, E. BRAUNWALD, M. S. SABATINE and M. P. BONACA

Edition

Journal of the American Heart Association, Hoboken, Wiley-Blackwell, 2021, 2047-9980

Other information

Language

English

Type of outcome

Článek v odborném periodiku

Field of Study

30201 Cardiac and Cardiovascular systems

Country of publisher

United States of America

Confidentiality degree

není předmětem státního či obchodního tajemství

References:

URL

Impact factor

Impact factor: 6.106

RIV identification code

RIV/00216224:14110/21:00122388

Organization unit

Faculty of Medicine

DOI

http://dx.doi.org/10.1161/JAHA.120.020446

UT WoS

000693361200005

Keywords in English

acute coronary syndrome; antiplatelet therapy; P2Y(12) inhibitor; PCI

Abstract

V originále

Background Coronary stent type and risk of stent thrombosis remain important factors affecting recommended duration of dual antiplatelet therapy. We investigated the efficacy and safety of long-term ticagrelor in patients with prior coronary stenting enrolled 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 and Results Patients in PEGASUS-TIMI 54 had a myocardial infarction 1 to 3 year prior and were randomized 1:1:1 to ticagrelor 60 or 90 mg BID or placebo. The primary end point was a composite of cardiovascular death, myocardial infarction, or stroke (major adverse cardiovascular events). Stent thrombosis was prospectively adjudicated (Academic Research Consortium definition). Baseline characteristics were compared by most recent stent type (bare metal versus drug-eluting stent and first- versus later-generation drug-eluting stent). Treatment arms were compared using Cox proportional hazards models. Of 21 162 patients randomized, 80% (n=16 891) had prior coronary stenting. Following randomization, myocardial infarction was the most frequent ischemic event in patients with prior stenting in the placebo arm, occurring in 5.2% of patients (Type 1: 4.1%), followed by cardiovascular death (2.3%), stroke (1.7%), and stent thrombosis (0.9%). Ticagrelor(pooled) reduced major adverse cardiovascular events (7.0% versus 8.0%; hazard ratio [HR], 0.85; 95% CI, 0.75-96) regardless of stent type (bare metal stent versus drug-eluting stent: p(interaction)=0.767; first versus later generation: p(interaction)=0.940). The rate of any stent thrombosis was numerically lower with ticagrelor(pooled) (0.7% versus 0.9%; HR, 0.73; 95% CI, 0.50-1.05) and Thrombolysis in Myocardial Infarction major bleeding was increased (HR, 2.65; 95% CI, 1.90-3.68). Conclusions Long-term ticagrelor reduces major adverse cardiovascular events in patients with prior myocardial infarction and coronary stenting regardless of stent type, with the benefit driven predominantly by reduction in de novo events. Nonfatal major bleeding is increased with ticagrelor. Registration Information clinicaltrials.gov. Identifier: NCT01225562.

Citovat

BERGMARK, B. A., D. L. BHATT, P. G. STEG, A. BUDAJ, R. F. STOREY, Y. GURMU, J. F. KUDER, K. IM, G. MAGNANI, T. O. OPHUIS, C. HAMM, Jindřich ŠPINAR, R. G. KISS, F. J. VAN DE WERF, G. MONTALESCOT, P. JOHANSON, E. BRAUNWALD, M. S. SABATINE and M. P. BONACA. Long-Term Ticagrelor in Patients With Prior Coronary Stenting in the PEGASUS-TIMI 54 Trial. Journal of the American Heart Association. Hoboken: Wiley-Blackwell, 2021, vol. 10, No 17, p. 1-18. ISSN 2047-9980. Available from: https://dx.doi.org/10.1161/JAHA.120.020446.

@article{1793179,
   author = {Bergmark, B. A. and Bhatt, D. L. and Steg, P. G. and Budaj, A. and Storey, R. F. and Gurmu, Y. and Kuder, J. F. and Im, K. and Magnani, G. and Ophuis, T. O. and Hamm, C. and Špinar, Jindřich and Kiss, R. G. and Van de Werf, F. J. and Montalescot, G. and Johanson, P. and Braunwald, E. and Sabatine, M. S. and Bonaca, M. P.},
   article_location = {Hoboken},
   article_number = {17},
   doi = {http://dx.doi.org/10.1161/JAHA.120.020446},
   keywords = {acute coronary syndrome; antiplatelet therapy; P2Y(12) inhibitor; PCI},
   language = {eng},
   issn = {2047-9980},
   journal = {Journal of the American Heart Association},
   title = {Long-Term Ticagrelor in Patients With Prior Coronary Stenting in the PEGASUS-TIMI 54 Trial},
   url = {https://www.ahajournals.org/doi/10.1161/JAHA.120.020446},
   volume = {10},
   year = {2021}
}

TY  - JOUR
ID  - 1793179
AU  - Bergmark, B. A. - Bhatt, D. L. - Steg, P. G. - Budaj, A. - Storey, R. F. - Gurmu, Y. - Kuder, J. F. - Im, K. - Magnani, G. - Ophuis, T. O. - Hamm, C. - Špinar, Jindřich - Kiss, R. G. - Van de Werf, F. J. - Montalescot, G. - Johanson, P. - Braunwald, E. - Sabatine, M. S. - Bonaca, M. P.
PY  - 2021
TI  - Long-Term Ticagrelor in Patients With Prior Coronary Stenting in the PEGASUS-TIMI 54 Trial
JF  - Journal of the American Heart Association
VL  - 10
IS  - 17
SP  - 1-18
EP  - 1-18
PB  - Wiley-Blackwell
SN  - 20479980
KW  - acute coronary syndrome
KW  - antiplatelet therapy
KW  - P2Y(12) inhibitor
KW  - PCI
UR  - https://www.ahajournals.org/doi/10.1161/JAHA.120.020446
N2  - Background Coronary stent type and risk of stent thrombosis remain important factors affecting recommended duration of dual antiplatelet therapy. We investigated the efficacy and safety of long-term ticagrelor in patients with prior coronary stenting enrolled 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 and Results Patients in PEGASUS-TIMI 54 had a myocardial infarction 1 to 3 year prior and were randomized 1:1:1 to ticagrelor 60 or 90 mg BID or placebo. The primary end point was a composite of cardiovascular death, myocardial infarction, or stroke (major adverse cardiovascular events). Stent thrombosis was prospectively adjudicated (Academic Research Consortium definition). Baseline characteristics were compared by most recent stent type (bare metal versus drug-eluting stent and first- versus later-generation drug-eluting stent). Treatment arms were compared using Cox proportional hazards models. Of 21 162 patients randomized, 80% (n=16 891) had prior coronary stenting. Following randomization, myocardial infarction was the most frequent ischemic event in patients with prior stenting in the placebo arm, occurring in 5.2% of patients (Type 1: 4.1%), followed by cardiovascular death (2.3%), stroke (1.7%), and stent thrombosis (0.9%). Ticagrelor(pooled) reduced major adverse cardiovascular events (7.0% versus 8.0%; hazard ratio [HR], 0.85; 95% CI, 0.75-96) regardless of stent type (bare metal stent versus drug-eluting stent: p(interaction)=0.767; first versus later generation: p(interaction)=0.940). The rate of any stent thrombosis was numerically lower with ticagrelor(pooled) (0.7% versus 0.9%; HR, 0.73; 95% CI, 0.50-1.05) and Thrombolysis in Myocardial Infarction major bleeding was increased (HR, 2.65; 95% CI, 1.90-3.68). Conclusions Long-term ticagrelor reduces major adverse cardiovascular events in patients with prior myocardial infarction and coronary stenting regardless of stent type, with the benefit driven predominantly by reduction in de novo events. Nonfatal major bleeding is increased with ticagrelor. Registration Information clinicaltrials.gov. Identifier: NCT01225562.
ER  -

BERGMARK, B. A., D. L. BHATT, P. G. STEG, A. BUDAJ, R. F. STOREY, Y. GURMU, J. F. KUDER, K. IM, G. MAGNANI, T. O. OPHUIS, C. HAMM, Jindřich ŠPINAR, R. G. KISS, F. J. VAN DE WERF, G. MONTALESCOT, P. JOHANSON, E. BRAUNWALD, M. S. SABATINE and M. P. BONACA. Long-Term Ticagrelor in Patients With Prior Coronary Stenting in the PEGASUS-TIMI 54 Trial. \textit{Journal of the American Heart Association}. Hoboken: Wiley-Blackwell, 2021, vol.~10, No~17, p.~1-18. ISSN~2047-9980. Available from: https://dx.doi.org/10.1161/JAHA.120.020446.

Detailed Information on Publication Record