PEGASUS-TIMI: Adding Ticagrelor to Aspirin Regime Shown to Cut Risk of Second Cardiac Event

Stable heart attack patients prescribed ticagrelor in addition to low-dose aspirin have lower risks of experiencing a secondary cardiac event, death or stroke, even after one year, according to the results of the PEGASUS-TIMI 54 Trial presented on Saturday, March 14 as part of ACC.15 and simultaneously published in the New England Journal of Medicine.

The double-blind study looked at 21,162 patients with a history of myocardial infarction (MI) from 1,144 health care providers in 31 countries who were randomly assigned to a twice-daily regimen of ticagrelor at 90 mg, ticagrelor at 60 mg or placebo. All patients had additional risk factors such as age or diabetes, and had experienced their heart attack one to three years prior to participating in the study.

Overall results found that both patient populations receiving ticagrelor in addition to aspirin had reduced chances of cardiovascular mortality, heart attack or stroke. Patients in the 90-mg group saw their risk of a second cardiac event decrease by 15 percent and patients in the 60-mg group saw their risk reduced by 16 percent as compared to the placebo patient group. In terms of bleeding, study investigators did note that ticagrelor increased the risk of TIMI major bleeding, but not fatal bleeding or intracerebral hemorrhage. In addition, while the two doses of ticagrelor had similar overall efficacy, bleeding and other side effects tended to be less frequent with the 60 mg bid dose. The study is the first to follow patients for more than one year.

“The benefit we saw was remarkably consistent across the individual components of the endpoint and in all the major subgroups of patients,” said Marc S. Sabatine, MD, MPH, FACC, the lead investigator for the study. “Moreover, we followed patients for an average of just under three years, and our event curves continue to spread out over time, suggesting that the benefit continues to accrue over time. Now that we have the evidence, when faced with a patient who has had a heart attack, based on these data, I would continue treatment with ticagrelor as long as the patient tolerated it.”

Clinical Topics: Acute Coronary Syndromes, Prevention

Keywords: Acute Coronary Syndrome, Adenosine, Aspirin, Coronary Artery Disease, Double-Blind Method, Incidence, Mass Casualty Incidents, Myocardial Infarction, Purinergic P2Y Receptor Antagonists, Secondary Prevention, Stroke, omega-Chloroacetophenone, ACC Annual Scientific Session


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