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  • Ducrocq, GregoryUniv Paris, French Alliance Cardiovasc Trials FACT, AP HP, INSERM,U1148, Paris, France. (author)

Balance of benefit and risk of ticagrelor in patients with diabetes and stable coronary artery disease according to bleeding risk assessment with the CRUSADE score : Data from THEMIS and THEMIS PCI

  • Article/chapterEnglish2022

Publisher, publication year, extent ...

  • Elsevier,2022
  • printrdacarrier

Numbers

  • LIBRIS-ID:oai:DiVA.org:uu-482123
  • https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-482123URI
  • https://doi.org/10.1016/j.ahj.2022.03.008DOI

Supplementary language notes

  • Language:English
  • Summary in:English

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  • Subject category:ref swepub-contenttype
  • Subject category:art swepub-publicationtype

Notes

  • Background The THEMIS trial demonstrated that in high-risk patients with stable coronary artery disease and diabetes without previous myocardial infarction or stroke, ticagrelor, in addition to aspirin, reduced the incidence of ischemic events but increased major bleeding. Identification of patients who could derive the greatest net benefit from the addition of ticagrelor appears important. We used the CRUSADE bleeding risk score to risk stratify the THEMIS population. Methods The population was divided into tertiles: score <= 22, 23 to 33, and >= 34. In each tertile, primary efficacy (composite of cardiovascular death, myocardial infarction, or stroke) and safety (TIMI major bleeding) outcomes were analyzed. NACE (net adverse clinical events) was defined as the irreversible harm composite, in which all-cause death, myocardial infarction, stroke, amputations, fatal bleeds, and intracranial hemorrhage were counted. Results Patients in the lower risk tertile experienced fewer ischemic events with ticagrelor than placebo, whereas there was no significant benefit from ticagrelor in the other tertiles (P-interaction = .008). Bleeding rates were consistently increased with ticagrelor across all tertiles (P-interaction = .79). Ticagrelor reduced NACE in the first tertile (HR = 0.74, 95% CI = 0.61-0.90) but not in the others (HR = 1.03, 95% CI = 0.86-1.23 and HR = 1.05, 95% CI = 0.91-1.22, respectively; P-interaction = .012). Conclusions In patients with stable coronary artery disease and diabetes without a history of myocardial infarction or stroke, only those at the lower end of the bleeding risk spectrum according to the CRUSADE score derived net benefit from ticagrelor.

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Added entries (persons, corporate bodies, meetings, titles ...)

  • Bhatt, Deepak L.Brigham & Womens Hosp, Heart & Vasc Ctr, 75 Francis St, Boston, MA 02115 USA.;Harvard Med Sch, Boston, MA 02115 USA. (author)
  • Lee, Jane J.Baim Inst Clin Res, Boston, MA USA. (author)
  • Kui, NaishuBaim Inst Clin Res, Boston, MA USA. (author)
  • Fox, Kim M.Imperial Coll, Royal Brampton Hosp, London, England. (author)
  • Harrington, Robert A.Stanford Univ, Dept Med, Stanford Ctr Clin Res, Stanford, CA 94305 USA. (author)
  • Leiter, Lawrence A.Univ Toronto, Li Ka Shing Knowledge Inst, St Michaels Hosp, Toronto, ON, Canada. (author)
  • Mehta, Shamir R.Hamilton Hlth Sci, Populat Hlth Res Inst, Hamilton, ON, Canada.;McMaster Univ, Hamilton, ON, Canada. (author)
  • Kiss, Robert GaborMagyar Honvedseg Egeszsegugyi Kozpont, Budapest, Hungary. (author)
  • James, Stefan,1964-Uppsala universitet,Institutionen för medicinska vetenskaper(Swepub:uu)stjam367 (author)
  • Vinereanu, DragosUniv Med & Pharm Carol Davila, Univ & Emergency Hosp, Bucharest, Romania. (author)
  • Huber, KurtWilhelminenhosp, Dept Med Cardiol & Intens Care Med 3, Vienna, Austria.;Sigmund Freud Univ, Med Fac, Vienna, Austria. (author)
  • Andersson, MarielleAstraZeneca BioPharmaceut Res & Dev, Gothenburg, Sweden. (author)
  • Himmelmann, AndersAstraZeneca BioPharmaceut Res & Dev, Gothenburg, Sweden. (author)
  • Simon, TabassomeSorbonne Univ, Hop St Antoine, AP HP SU, FACT,Dept Clin Pharmacol & Clin Res Platform East, Paris, France. (author)
  • Steg, Ph GabrielUniv Paris, French Alliance Cardiovasc Trials FACT, AP HP, INSERM,U1148, Paris, France.;Imperial Coll, Royal Brampton Hosp, London, England. (author)
  • Univ Paris, French Alliance Cardiovasc Trials FACT, AP HP, INSERM,U1148, Paris, France.Brigham & Womens Hosp, Heart & Vasc Ctr, 75 Francis St, Boston, MA 02115 USA.;Harvard Med Sch, Boston, MA 02115 USA. (creator_code:org_t)

Related titles

  • In:American Heart Journal: Elsevier249, s. 23-330002-87031097-6744

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