Reduction in Subtypes and Sizes of Myocardial Infarction With Ticagrelor in PEGASUS–TIMI 54. Issue 22 (20th November 2018)

• Record Type: Journal Article
• Authors: Bonaca, Marc P.; Wiviott, Stephen D.; Morrow, David A.; Steg, P. Gabriel; Hamm, Christian; Bhatt, Deepak L.; Storey, Robert F.; Cohen, Marc; Kuder, Julia; Im, KyungAh; Magnani, Giulia; Budaj, Andrzej; Nicolau, José C.; Parkhomenko, Alexander; López‐Sendón, José; Dellborg, Mikael; Diaz, Rafael; Van de Werf, Frans; Corbalán, Ramón; Goudev, Assen; Jensen, Eva C.; Johanson, Per; Braunwald, Eugene; Sabatine, Marc S.
• Is Part Of: Journal of the American Heart Association. Volume 7:Issue 22(2018)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2018-11-20
• Subjects: antiplatelet therapy -- myocardial infarction -- ST‐segment elevation myocardial infarction -- ticagrelor -- troponin; Heart -- Diseases -- Periodicals; Cardiovascular system -- Diseases -- Periodicals; Cerebrovascular disease -- Periodicals; Cardiology -- Periodicals; 616.1
• DOI: 10.1161/JAHA.118.009260
• Languages: English
• ISSNs: 2047-9980

Abstract

Abstract : Background: Ticagrelor reduced cardiovascular death, myocardial infarction (MI), or stroke in patients with prior MI in PEGASUS‐TIMI 54 (Prevention of Cardiovascular Events [eg, Death From Heart or Vascular Disease, Heart Attack, or Stroke] in Patients With Prior Heart Attack Using Ticagrelor Compared to Placebo on a Background of Aspirin). MI can occur in diverse settings and with varying severity; therefore, understanding the types and sizes of MI events prevented is of clinical importance. Methods and Results: MIs were adjudicated by a blinded clinical events committee and categorized by subtype and fold elevation of peak cardiac troponin over the upper limit of normal. A total of 1042 MIs occurred in 898 of the 21 162 randomized patients over a median follow‐up of 33 months. The majority of the MIs (76%) were spontaneous (Type 1), with demand MI (Type 2) and stent thrombosis (Type 4b) accounting for 13% and 9%, respectively; sudden death (Type 3), percutaneous coronary intervention–related (Type 4a) and coronary artery bypass graft–related (Type 5) each accounted for <1%. Half of MIs (520, 50%) had a peak troponin ≥10x upper limit of normal and 21% of MIs (220) had a peak troponin ≥100× upper limit of normal. A total of 21% (224) were ST‐segment–elevation MI STEMI. Overall ticagrelor reduced MI (4.47% versus 5.25%, hazard ratio 0.83, 95% confidence interval 0.72–0.95, P =0.0055). The benefit was consistent among the subtypes, including a 31% reduction in MIs with a peak troponin ≥100× upper limit of normal (hazard ratio 0.69, 95% confidence interval 0.53–0.92, P =0.0096) and a 40% reduction in ST‐segment elevation MI (hazard ratio 0.60, 95% confidence interval 0.46–0.78, P =0.0002). Conclusions: In stable outpatients with prior MI, the majority of recurrent MIs are spontaneous and associated with a high biomarker elevation. Ticagrelor reduces the MI consistently among subtypes and sizes including large MIs and ST‐segment elevation MI. Clinical Trial Registration: URL: https://www.clinicaltrials.gov . Unique identifier: NCT01225562. Abstract : See Article by Bittl