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. The rate of any stent thrombosis was numerically lower with ticagrelor (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). Ticagrelor reduced major adverse cardiovascular events (7.0% versus 8.0% hazard ratio, 0.85 95% CI, 0.75-96) regardless of stent type (bare metal stent versus drug-eluting stent: p=0.767 first versus later generation: p=0.940). 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%). Of 21 162 patients randomized, 80% (n=16 891) had prior coronary stenting. Treatment arms were compared using Cox proportional hazards models. Baseline characteristics were compared by most recent stent type (bare metal versus drug-eluting stent and first- versus later-generation drug-eluting stent). Stent thrombosis was prospectively adjudicated (Academic Research Consortium definition). The primary end point was a composite of cardiovascular death, myocardial infarction, or stroke (major adverse cardiovascular events). a new subanalysis from the phase iii pegasus-timi 54 trial, which was presented at the european society of cardiology (esc) congress (2630 august, barcelona, spain), indicates that 60mg twice daily ticagrelor (brilinta, astrazeneca) is associated with a 29 risk reduction in cardiovascular death (p0. 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. 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. PEGASUS-TIMI 54 number, NCT01225562. Background Coronary stent type and risk of stent thrombosis remain important factors affecting recommended duration of dual antiplatelet therapy.
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