Baseline caffeine intake in cups per week was prospectively collected for 9694 patients. © The Author(s) 2019.This prespecified analysis used data from the 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) trial, which randomized 21 162 patients with prior myocardial infarction to ticagrelor 60 mg or 90 mg or matching placebo (twice daily). Published on behalf of the European Society of Cardiology. These data highlight the benefits of DAPT in prevention of spontaneous atherothrombotic events and indicate that long-term ticagrelor may be considered in high-risk patients with prior MI even if they have not been treated with stenting.Īntiplatelet drugs Dual antiplatelet therapy Medically managed Myocardial infarction Ticagrelor. Long-term ticagrelor reduces thrombotic events in patients with prior MI regardless of whether they had prior coronary stenting. The relative risk reduction in MACE with ticagrelor (pooled doses) was similar in patients without (HR 0.82, 95% CI 0.68-0.99) and with prior stenting (HR 0.85, 95% CI 0.75-0.96 P for interaction = 0.76). Patients without history of coronary stenting had higher baseline risk of MACE. The primary efficacy outcome (MACE) was the composite of cardiovascular death, MI, or stroke. A total of 4199 patients had no history of coronary stenting at baseline. This was a pre-specified analysis from PEGASUS-TIMI 54, which randomized 21 162 patients with prior MI (1-3 years) and additional high-risk features to ticagrelor 60 mg, 90 mg, or placebo twice daily in addition to aspirin. While much of the discussion around prolonged DAPT has been focused on stented patients, patients with prior MI without prior coronary stenting comprise a clinically important subgroup. PEGASUS-TIMI 54 demonstrated that long-term dual antiplatelet therapy (DAPT) with aspirin and ticagrelor reduced the risk of major adverse cardiovascular events (MACE), with an acceptable increase in bleeding, in patients with prior myocardial infarction (MI). 14 CPC Clinical Research, University of Colorado School of Medicine, 13199 E Montview Blvd Suite 200, Aurora, CO, USA.13 AstraZeneca, 431 53 Mölndal, Sweden.12 College of Medicine, University of the Philippines/Philippine Heart Center, East, Quezon City, Metro Manila, Philippines.11 Department of Cardiology, Military Hospital, Róbert Károly krt., 1134 Budapest, Hungary.10 Cardiovascular Division, Faculty of Medicine, Pontificia Universidad Católica de Chile, Lira 40, Santiago, Chile.9 Drammen Heart Center, DronninggDrammen, Norway.8 Department of Cardiology, Stavanger University Hospital, Gerd Ragna Bloch Thorsens gate 8, Stavanger, Norway.7 Centre of Postgraduate Medical Education, Grochowski Hospital, Grenadierów 51/59, 04-073 Warsaw, Poland.6 University Hospital Brno, 20 Jihlavska, Brno, Czech Republic.5 Assistance Publique-Hôpitaux de Paris, 3 Avenue Victoria, 75004 Paris, France.4 University of Sheffield, Western Bank, Sheffield S10 2TN, UK.3 University Hospital of Parma, Via Gramsci, 14, 43126 Parma PR, Italy.2 Instituto do Coracao (InCor), Hospital das Clinicas da Faculdade de Medicina, Universidade de Sao Paulo, Av Dr Eneas de Carvalho Aguiar 44, 05403 Sao Paulo, Brazil. ![]() 1 TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, USA.
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