Long-Term Use of Ticagrelor in Patients with Prior Myocardial Infarction

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dc.contributor.authorBonaca, M.P.
dc.contributor.authorBhatt, D.L.
dc.contributor.authorCohen, M.
dc.contributor.authorSteg, P.G.
dc.contributor.authorStorey, R.F.
dc.contributor.authorJensen, E.C.
dc.contributor.authorMagnani, G.
dc.contributor.authorBansilal, S.
dc.contributor.authorFish, M.P.
dc.contributor.authorIm, K.
dc.contributor.authorBengtsson, O.
dc.contributor.authorOphuis, T.O.
dc.contributor.authorBudaj, A.
dc.contributor.authorTheroux, P.
dc.contributor.authorRuda, M.
dc.contributor.authorHamm, C.
dc.contributor.authorGoto, S.
dc.contributor.authorSpinar, J.
dc.contributor.authorNicolau, J.C.
dc.contributor.authorKiss, R.G.
dc.contributor.authoret al.
dc.date.issued2015
dc.description.abstractBackground: The potential benefit of dual antiplatelet therapy beyond 1 year after a myocardial infarction has not been established. We investigated the efficacy and safety of ticagrelor, a P2Y12 receptor antagonist with established efficacy after an acute coronary syndrome, in this context. Methods: We randomly assigned, in a double-blind 1:1:1 fashion, 21,162 patients who had had a myocardial infarction 1 to 3 years earlier to ticagrelor at a dose of 90 mg twice daily, ticagrelor at a dose of 60 mg twice daily, or placebo. All the patients were to receive low-dose aspirin and were followed for a median of 33 months. The primary efficacy end point was the composite of cardiovascular death, myocardial infarction, or stroke. The primary safety end point was Thrombolysis in Myocardial Infarction (TIMI) major bleeding. Results: The two ticagrelor doses each reduced, as compared with placebo, the rate of the primary efficacy end point, with Kaplan–Meier rates at 3 years of 7.85% in the group that received 90 mg of ticagrelor twice daily, 7.77% in the group that received 60 mg of ticagrelor twice daily, and 9.04% in the placebo group (hazard ratio for 90 mg of ticagrelor vs. placebo, 0.85; 95% confidence interval [CI], 0.75 to 0.96; P = 0.008; hazard ratio for 60 mg of ticagrelor vs. placebo, 0.84; 95% CI, 0.74 to 0.95; P = 0.004). Rates of TIMI major bleeding were higher with ticagrelor (2.60% with 90 mg and 2.30% with 60 mg) than with placebo (1.06%) (P<0.001 for each dose vs. placebo); the rates of intracranial hemorrhage or fatal bleeding in the three groups were 0.63%, 0.71%, and 0.60%, respectively. Conclusions: In patients with a myocardial infarction more than 1 year previously, treatment with ticagrelor significantly reduced the risk of cardiovascular death, myocardial infarction, or stroke and increased the risk of major bleeding.
dc.identifier.citationNew England Journal of Medicine, 2015; 372(19):1791-1800
dc.identifier.doi10.1056/NEJMoa1500857
dc.identifier.issn0028-4793
dc.identifier.issn1533-4406
dc.identifier.orcidArstall, M. [0000-0003-0760-6382]
dc.identifier.orcidHorowitz, J. [0000-0001-6883-0703]
dc.identifier.urihttps://hdl.handle.net/2440/146067
dc.language.isoen
dc.publisherMassachusetts Medical Society
dc.rights© 2015 Massachusetts Medical Society. For personal use only. No other uses without permission. All rights reserved.
dc.source.urihttps://doi.org/10.1056/nejmoa1500857
dc.subjectdual antiplatelet therapy; myocardial infarction; ticagrelor; P2Y12
dc.subject.meshHumans
dc.subject.meshIntracranial Hemorrhages
dc.subject.meshCardiovascular Diseases
dc.subject.meshMyocardial Infarction
dc.subject.meshHemorrhage
dc.subject.meshAspirin
dc.subject.meshAdenosine
dc.subject.meshPlatelet Aggregation Inhibitors
dc.subject.meshDrug Therapy, Combination
dc.subject.meshDrug Administration Schedule
dc.subject.meshRisk
dc.subject.meshDouble-Blind Method
dc.subject.meshAged
dc.subject.meshMiddle Aged
dc.subject.meshFemale
dc.subject.meshMale
dc.subject.meshSecondary Prevention
dc.subject.meshKaplan-Meier Estimate
dc.subject.meshPurinergic P2Y Receptor Antagonists
dc.subject.meshTicagrelor
dc.titleLong-Term Use of Ticagrelor in Patients with Prior Myocardial Infarction
dc.typeJournal article
pubs.publication-statusPublished

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