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Reduction in subtyp...
Reduction in subtypes and sizes of myocardial infarction with ticagrelor in PEGASUS-TIMI 54
- Article/chapterEnglish2018
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LIBRIS-ID:oai:gup.ub.gu.se/273951
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https://gup.ub.gu.se/publication/273951URI
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https://doi.org/10.1161/JAHA.118.009260DOI
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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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Wiviott, S. D.
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Morrow, D. A.
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Steg, P. G.
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Hamm, C.
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Bhatt, D. L.
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Storey, R. F.
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Cohen, M.
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Kuder, J.
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Im, K.
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Magnani, G.
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Budaj, A.
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Nicolau, J. C.
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Parkhomenko, A.
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Sendón, J. L.
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Dellborg, Mikael,1954Gothenburg University,Göteborgs universitet,Institutionen för medicin,Institute of Medicine(Swepub:gu)xdelmi
(author)
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Diaz, R.
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Werf, F. V. D.
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Corbalán, R.
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Goudev, A.
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Jensen, E. C.
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Johanson, P.
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Braunwald, E.
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Sabatine, M. S.
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Göteborgs universitetInstitutionen för medicin
(creator_code:org_t)
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In:Journal of the American Heart Association7:222047-9980
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Bonaca, M. P.
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Wiviott, S. D.
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Morrow, D. A.
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Steg, P. G.
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Hamm, C.
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Bhatt, D. L.
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Storey, R. F.
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Cohen, M.
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Kuder, J.
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Im, K.
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Magnani, G.
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Budaj, A.
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Nicolau, J. C.
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Parkhomenko, A.
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Sendón, J. L.
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Dellborg, Mikael ...
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Diaz, R.
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Werf, F. V. D.
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Corbalán, R.
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Goudev, A.
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Jensen, E. C.
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Johanson, P.
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Braunwald, E.
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Sabatine, M. S.
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- MEDICAL AND HEALTH SCIENCES
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and Clinical Medicin ...
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and Cardiac and Card ...
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University of Gothenburg