Low-Dose Ticagrelor in Patients With High Ischemic Risk and Previous Myocardial Infarction: A Multicenter Prospective...

Area of Science:

• Cardiology
• Pharmacology
• Clinical Research

Background:

• Prolonged dual antiplatelet therapy (DAPT) after myocardial infarction (MI) aims to reduce long-term ischemic events.
• The PEGASUS-TIMI 54 trial demonstrated efficacy of low-dose ticagrelor (60 mg twice daily) plus aspirin post-MI.
• Real-world data on the use and outcomes of prolonged low-dose ticagrelor therapy are limited.

Purpose of the Study:

• To evaluate the real-world prescription criteria, clinical characteristics, and 1-year outcomes of patients receiving low-dose ticagrelor for prolonged DAPT after MI.
• To assess the safety and effectiveness of ticagrelor 60 mg in a real-world cohort based on Italian national regulations.

Main Methods:

• A prospective, real-world study enrolling 181 consecutive patients eligible for ticagrelor 60 mg in three Italian centers.
• Data collection included patient demographics, prescription criteria, major adverse cardiovascular events (MACE), and bleeding events over a median follow-up of 18 months.
• Analysis focused on 1-year outcomes, including rates of MI, stroke/transient ischemic attack, and major bleeding.

Main Results:

• Multivessel coronary disease (72.4%) was the most common prescription criterion; chronic kidney disease (15.5%) was the least common.
• At 1-year follow-up, the rate of MACE was 4.97%, comprising 3.86% for MI and 1.1% for stroke/transient ischemic attack.
• No major bleeding events were reported during the follow-up period.

Conclusions:

• Real-world use of low-dose ticagrelor for prolonged DAPT in patients with previous MI is effective in reducing ischemic events.
• The treatment demonstrated a favorable safety profile, with no major bleeding observed in this cohort.
• Findings support the use of ticagrelor 60 mg for extended DAPT in selected post-MI patients in routine clinical practice.