- Long-term dual antiplatelet therapy (DAPT) with ticagrelor and aspirin decreased atherothrombotic risk in patients with prior myocardial infarction (MI) irrespective of previous coronary stenting.
- Risk reduction was higher in patients without stenting compared to those with stenting.
Why this matters
- Findings highlight the benefits of DAPT in the prevention of spontaneous atherothrombotic events and suggest that ticagrelor may be considered for long-term in high-risk patients with prior MI and no history of stenting.
- The PEGASUS-TIMI 54 study of 21,090 patients with prior MI (1-3 years; 4199 without stenting and 16,891 with ≥1 stents) who were randomly assigned to receive ticagrelor (60 and 90 mg) or placebo twice daily in addition to aspirin.
- Primary outcomes: major adverse cardiovascular events (MACEs; cardiovascular (CV) death, MI and stroke).
- Exploratory net clinical outcome: composite of CV death, MI, stroke, fatal bleeding or intracranial haemorrhage.
- Funding: AstraZeneca to Brigham and Women’s Hospital.
- Within the placebo group, patients without stenting had a higher absolute risk for MACEs vs those with stenting (HR, 1.41; 95% CI, 1.15-1.73; P=.0008).
- Risk reduction in MACE with ticagrelor was similar in patients without (HR, 0.82; 95% CI, 0.68-0.99) and with (HR, 0.85; 95% CI, 0.75-0.96; Pinteraction=.76) stenting.
- Ticagrelor vs placebo group had a lower risk for CV death (HR, 0.80; 95% CI, 0.62-1.03; P=.087) and all-cause mortality (HR, 0.79; 95% CI, 0.64-0.99; P=.036) in patients without stenting.
- The risk for major bleeding increased with ticagrelor in patients without (HR, 1.93; 95% CI, 0.99-3.78) and with (HR, 2.65; 95% CI, 1.90-3.68; Pinteraction=.41) stenting.
- Subgroup analysis was not powered for all MACE components and safety endpoints.