Abstract 11594: Reduction in Subtypes and Sizes of Myocardial Infarction With Ticagrelor in PEGASUS-TIMI 54
Objective: Ticagrelor reduced the risk of CV death, MI or stroke (MACE) in stable patients with prior MI in PEGASUS-TIMI 54. We investigated the efficacy of ticagrelor in reducing different subtypes and sizes of MI.
Methods: MIs were adjudicated by the blinded TIMI Clinical Events Committee with definitions consistent with the Third Universal Definition of MI. Each MI was categorized by subtype and fold elevation of peak troponin (Tn) over the upper limit of normal (ULN). Results for both doses of ticagrelor were pooled in comparison to placebo.
Results: A total of 1042 MIs occurred in the 21,162 randomized patients over a median follow up of 33 months. The majority (76%) of the MIs were spontaneous (Type 1), with demand MI (Type 2) and PCI-related (Type 4) accounting for 13% and 10% respectively (Figure Left); sudden death MI (Type 3) and CABG-related MI (Type 5) each accounted for <1%. Using fold elevation in Tn, half of MIs (520, 50%) had a peak Tn ≥10x ULN and 21% of MIs (220) had a peak Tn ≥100x ULN (Figure Right). A total of 21% (224) were STEMI. Overall ticagrelor reduced MI at 3 yrs (4.47% vs 5.25%, HR 0.83, 95% CI 0.72 - 0.95, p=0.0055). The benefit was highly consistent among the different subtypes of MI (Figure left) and with increasing size of MI by fold elevation of Tn (Figure right) and for STEMI (HR 0.60, 95% CI 0.46 - 0.78, p=0.0002).
Conclusion: In stable outpatients with a history of MI the majority of recurrent MI events are spontaneous and associated with a high biomarker elevation. Ticagrelor significantly reduces the incidence of MI consistently among different subtypes and biomarker sizes, with the greatest absolute reduction in spontaneous MIs, large MIs, and STEMI.
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- © 2015 by American Heart Association, Inc.