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Long-term use of ticagrelor in patients with prior myocardial infarction
Marc P Bonaca1, Deepak L Bhatt, Marc Cohen
1From the Thrombolysis in Myocardial Infarction (TIMI) Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston (M.P.B., D.L.B., G.M., M.P.F., K.I., S.A.M., S.D.W., E.B., M.S.S.); the Cardiovascular Division, Department of Medicine, Newark Beth Israel Medical Center, Rutgers-New Jersey Medical School, Newark (M.C.); French Alliance for Cardiovascular Trials, Département Hospitalo-Universitaire Fibrosis, Inflammation, Remodeling, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, INSERM Unité 1148, and Université Paris-Diderot, Sorbonne Paris Cité - all in Paris (P.G.S.); National Heart and Lung Institute, Royal Brompton Hospital, Imperial College, London (P.G.S.), and Department of Cardiovascular Science, University of Sheffield, Sheffield, United Kingdom (R.F.S.); AstraZeneca, Mölndal, Sweden (E.C.J., O.B., P.H.); Icahn School of Medicine at Mount Sinai, New York (S.B.); Canisius-Wilhelmina Hospital, Nijmegen, the Netherlands (T.O.O.); Postgraduate Medical School, Grochowski Hospital, Warsaw, Poland (A.B.); Montreal Heart Institute, Université de Montréal, Montreal (P.T.); Cardiology Research Center, Moscow (M.R.); Kerckhoff Heart Center, Bad Nauheim, and University of Giessen, Giessen - both in Germany (C.H.); Department of Medicine (Cardiology), Tokai University School of Medicine, Isehara, Japan (S.G.); University Hospital, Jihlavska, Brno, Czech Republic (J.S.); Heart Institute (InCor)-University of São Paulo Medical School, São Paulo (J.C.N.); and the Department of Cardiology, Military Hospital, Budapest, Hungary (R.G.K.).
Extended dual antiplatelet therapy with ticagrelor after myocardial infarction significantly reduced major adverse cardiovascular events. However, ticagrelor also increased the risk of major bleeding events in patients.
Area of Science:
- Cardiology
- Pharmacology
- Clinical Trials
Background:
- The long-term benefits of dual antiplatelet therapy (DAPT) post-myocardial infarction (MI) remain unclear.
- Ticagrelor, a P2Y12 receptor antagonist, has proven efficacy in acute coronary syndromes.
Purpose of the Study:
- To evaluate the efficacy and safety of extended ticagrelor therapy beyond one year in patients with a history of myocardial infarction.
- To compare two different doses of ticagrelor (90 mg twice daily and 60 mg twice daily) against placebo.
Main Methods:
- A double-blind, randomized trial involving 21,162 patients with MI 1-3 years prior.
- Patients received low-dose aspirin plus either ticagrelor (90 mg BID, 60 mg BID) or placebo.
- Primary efficacy endpoint: composite of cardiovascular death, MI, or stroke. Primary safety endpoint: Thrombolysis in Myocardial Infarction (TIMI) major bleeding.
Main Results:
- Both ticagrelor doses significantly reduced the primary efficacy endpoint compared to placebo (3-year rates: 7.85% for 90 mg, 7.77% for 60 mg, vs. 9.04% for placebo).
- Ticagrelor significantly increased TIMI major bleeding rates (2.60% for 90 mg, 2.30% for 60 mg) versus placebo (1.06%).
- Rates of intracranial hemorrhage or fatal bleeding were similar across groups.
Conclusions:
- In patients with prior MI, ticagrelor therapy beyond one year effectively lowers the risk of cardiovascular death, MI, or stroke.
- Ticagrelor treatment is associated with an increased risk of major bleeding events.
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