Long-term ticagrelor for secondary prevention in patients with prior myocardial infarction and no history of coronary stenting: insights from PEGASUS-TIMI 54
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View abstract on PubMed
Summary
This summary is machine-generated.Long-term dual antiplatelet therapy (DAPT) with aspirin and ticagrelor effectively reduces major adverse cardiovascular events (MACE) in patients with prior myocardial infarction (MI). This benefit extends to high-risk patients even without prior coronary stenting.
Area Of Science
- Cardiology
- Pharmacology
- Clinical Trials
Background
- Dual antiplatelet therapy (DAPT) with aspirin and ticagrelor has shown efficacy in reducing major adverse cardiovascular events (MACE) in patients with prior myocardial infarction (MI).
- The benefit of prolonged DAPT has been extensively studied in patients with coronary stenting, but a significant subgroup of patients with prior MI but without stenting requires specific consideration.
Purpose Of The Study
- To evaluate the efficacy and safety of long-term DAPT with ticagrelor and aspirin in patients with prior MI, specifically analyzing outcomes in those without a history of coronary stenting.
- To determine if the risk reduction of MACE observed in the PEGASUS-TIMI 54 trial is consistent across patients with and without prior coronary stenting.
Main Methods
- A pre-specified analysis of the PEGASUS-TIMI 54 trial, which randomized 21,162 patients with prior MI and high-risk features to ticagrelor (60mg or 90mg) or placebo plus aspirin.
- Included 4,199 patients with no history of coronary stenting at baseline, comparing their outcomes to those with prior stenting.
Main Results
- Patients without prior stenting had a higher baseline risk of MACE compared to those with prior stenting (13.2% vs. 8.0% in the placebo arm).
- Long-term ticagrelor (pooled doses) demonstrated a similar relative risk reduction in MACE for patients without prior stenting (HR 0.82) and with prior stenting (HR 0.85), with no significant interaction (P=0.76).
Conclusions
- Long-term treatment with ticagrelor in addition to aspirin effectively reduces thrombotic events in patients with prior MI, irrespective of prior coronary stenting.
- High-risk patients with prior MI, even without stenting, may benefit from long-term ticagrelor therapy for the prevention of spontaneous atherothrombotic events.
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