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Balancing the Risks and Benefits of Dual Platelet Inhibition. N Engl J Med 2015 Mar 14.Įditorial Comment: Keaney JF Jr. Long-Term Use of Ticagrelor in Patients With Prior Myocardial Infarction. Marc Bonaca at the European Society of Cardiology Congress, Rome, Italy, August 30, 2016.īonaca MP, Bhatt DL, Cohen M, et al., on behalf of the PEGASUS-TIMI 54 Steering Committee and Investigators. Prevention of Stroke With Ticagrelor in Patients With Prior Myocardial Infarction: Insights From PEGASUS-TIMI 54 (Prevention of Cardiovascular Events in Patients With Prior Heart Attack Using Ticagrelor Compared to Placebo on a Background of Aspirin-Thrombolysis in Myocardial Infarction 54). J Am Coll Cardiol 2017 70:527-38.īonaca MP, Goto S, Bhatt DL, et al. Cost-Effectiveness of Long-Term Ticagrelor in Patients With Prior Myocardial Infarction: Results From the PEGASUS-TIMI 54 Trial. Ticagrelor for Secondary Prevention of Atherothrombotic Events in Patients With Multivessel Coronary Disease. Eur Heart J 2019 Dec 7.īansilal S, Bonaca MP, Cornel JH, et al. Long-term ticagrelor for secondary prevention in patients with prior myocardial infarction and no history of coronary stenting: insights from PEGASUS-TIMI 54. 5.2% with placebo (HR 0.81, p = 0.008 p for interaction = 0.74)įurtado RH, Nicolau JC, Magnani G, et al. MI among those with prior coronary stent: 4.4% with ticagrelor vs.MI among those with no prior coronary stent: 4.8% with ticagrelor vs.Cardiovascular death, MI, or stroke among those with prior coronary stent: 7.0% with ticagrelor vs.Cardiovascular death, MI, or stroke among those with no prior coronary stent: 11.1% with ticagrelor vs.Ticagrelor was associated with an increase in major bleeding (HR 2.67, p < 0.0001), but not intracranial hemorrhage.Ĭoronary stent (n = 16,891) vs. Among these, ticagrelor was associated with a reduction in major adverse cardiac events (HR 0.82, p = 0.004) and coronary events (HR 0.76, p < 0.0001). Multivessel coronary disease: A total of 59.4% of patients had multivessel coronary artery disease.

placebo = 2.7, p 1 prior MI, multivessel disease, diabetes, renal dysfunction, age <75 years, and peripheral artery disease.

TIMI major bleeding: 2.6% with ticagrelor 90 mg (HR vs.

The association of ticagrelor on the primary outcome was the same in all tested subgroups. This translates into 83 individuals who need to be treated to prevent one adverse event. placebo = 0.85, p = 0.008), 7.8% of the ticagrelor 60 mg bid group (HR vs. The primary outcome of cardiovascular death, MI, or stroke occurred in 7.8% of the ticagrelor 90 mg bid group (hazard ratio vs.

Recent gastrointestinal bleed or major surgery.

History of ischemic stroke, intracranial hemorrhage, central nervous system tumor, or vascular abnormality.

Subjects at least 50 years of age with at least one of the following:

History of ST-segment elevation MI (STEMI): 53%.

Median time from qualifying MI: 1.7 years.

History of percutaneous coronary intervention: 83%.

Duration of follow-up: median 33 months.

Subjects with a history of MI (1-3 years prior) on aspirin therapy were randomized to ticagrelor 90 mg bid (n = 7,050) or ticagrelor 60 mg bid (n = 7,045) versus placebo (n = 7,067).