Pegasus study – long‑term dual antiaggregation therapy (ASA + ticagrelor) following myocardial infarction

Czech version

Authors: J. Špinar ¹; L. Špinarová ²; J. Vítovec ²
Authors‘ workplace: Interní kardiologická klinika LF MU a FN Brno ¹; I. interní kardioangiologická klinika LF MU a FN u sv. Anny v Brně ²
Published in: Kardiol Rev Int Med 2015, 17(1): 41-45
Category: Cardiology Review

Overview

Background:
Ticagrelor is a P2Y₁₂ receptor antagonist that has been shown to reduce the incidence of ischemic events for up to a year after an myocardial infarction acute coronary syndrome. The efficacy and safety of long‑term ticagrelor therapy beyond 1 year after a myocardial infarction is was unknown.

Methods:
We randomized 21,162 patients with a history of myocardial infarction within the previous 1– 3 years on a double‑blind basis 1 : 1 : 1 fashion to ticagrelor 90 mg twice daily, ticagrelor 60 mg twice daily, or placebo, all treated with low‑dose aspirin, and followed them up for a median of 33 months. The primary efficacy endpoint was the composite of cardiovascular death, myocardial infarction, or stroke. The primary safety endpoint was TIMI major bleeding.

Results:
Both doses of ticagrelor significantly reduced the primary efficacy endpoint at 3 years compared to placebo, with Kaplan‑ Meier rates at 3 years of 7.85% with ticagrelor 90 mg, 7.77% with ticagrelor 60 mg, and 9.04% with placebo (HR for ticagrelor 90 mg vs. placebo was 0.85, 95% CI 0.75– 0.96, p = 0.0080; HR for ticagrelor 60 mg vs. placebo was 0.84, 95% CI 0.74– 0.95, p = 0.0043). The rates of TIMI major bleeding were higher with ticagrelor (2.60% for 90 mg, 2.30% for 60 mg and 1.06% for placebo, p < 0.001 for each dose against placebo); the rates of fatal intracranial hemorrhage or fatal bleeding were 0.63%, 0.71%, and 0.60% in the 3 arms, respectively.

Conclusions:
Treatment with ticagrelor of patients more than 1 year after a myocardial infarction with ticagrelor reduces the risk of cardiovascular death, myocardial infarction, or stroke, and slightly increases the risk of major bleeding.

Keywords:
ticagrelor – myocardial infarction – secondary prevention

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