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Reduction in subtypes and sizes of myocardial infarction with ticagrelor in PEGASUS-TIMI 54

Artikel i vetenskaplig tidskrift
Författare M. P. Bonaca
S. D. Wiviott
D. A. Morrow
P. G. Steg
C. Hamm
D. L. Bhatt
R. F. Storey
M. Cohen
J. Kuder
K. Im
G. Magnani
A. Budaj
J. C. Nicolau
A. Parkhomenko
J. L. Sendón
Mikael Dellborg
R. Diaz
F. V. D. Werf
R. Corbalán
A. Goudev
E. C. Jensen
P. Johanson
E. Braunwald
M. S. Sabatine
Publicerad i Journal of the American Heart Association
Volym 7
Nummer/häfte 22
ISSN 2047-9980
Publiceringsår 2018
Publicerad vid Institutionen för medicin
Språk en
Länkar dx.doi.org/10.1161/JAHA.118.009260
Ämnesord Antiplatelet therapy, Myocardial infarction, ST-segment elevation myocardial infarction, Ticagrelor, Troponin
Ämneskategorier Kardiologi

Sammanfattning

Background-—Ticagrelor reduced cardiovascular death, myocardial infarction (MI), or stroke in patients with prior MI in PEGASUSTIMI 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 ≥1009 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 ≥1009 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. © 2018 The Authors.

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