"Ticagrelor in Patients 1 to 3 Years after Myocardial Infarction".
The New England Journal of Medicine.
Date Published.
PMID•Full text•PDF

Contents

1 Clinical Question
2 Bottom Line
3 Major Points
4 Guidelines
5 Design
6 Population
6.1 Inclusion Criteria
6.2 Exclusion Criteria
6.3 Baseline Characteristics
7 Interventions
8 Outcomes
8.1 Primary Outcomes
8.2 Secondary Outcomes
9 Funding
10 Further Reading

Clinical Question

Does long-term use of ticagrelor reduce the risk of cardiovascular events in patients with a history of myocardial infarction?

Bottom Line

In patients 1 to 3 years after a myocardial infarction, long-term ticagrelor at doses of either 90 mg or 60 mg twice daily reduced the risk of cardiovascular death, myocardial infarction, or stroke compared to placebo, but increased the risk of major bleeding.

Major Points

Guidelines

At the time of the study, guidelines recommended P2Y12 receptor antagonists for up to 1 year post-myocardial infarction. This trial suggests potential modification of these recommendations might be warranted to extend the duration of P2Y12 receptor antagonist therapy in post-myocardial infarction patients.

Design

- Multicenter, double-blind, placebo-controlled, randomized trial
- N=21,162
- Randomization to ticagrelor 90 mg twice daily, ticagrelor 60 mg twice daily, or placebo
- Median follow-up: 33 months

Population

- Patients aged ≥50 with a history of myocardial infarction 1 to 3 years prior
- Additional risk factors such as age ≥65, diabetes mellitus, another MI, multivessel coronary disease, or chronic renal dysfunction

Interventions

- Ticagrelor 90 mg twice daily vs. ticagrelor 60 mg twice daily vs. placebo, in addition to low-dose aspirin (75-150 mg daily)

Outcomes

Primary Outcomes
- Composite of cardiovascular death, myocardial infarction, or stroke
- Ticagrelor 90 mg twice daily (7.85%) and 60 mg twice daily (7.77%) each reduced the rate compared to placebo (9.04%)
Secondary Outcomes
- TIMI major bleeding was higher with ticagrelor (2.60% with 90 mg, 2.30% with 60 mg) compared to placebo (1.06%)

Funding

- The trial was funded by AstraZeneca.

Further Reading

- Full text article available at NEJM.org.