Subgroup benefits from long-term DAPT

Ticagrelor tablets

Photo courtesy of AstraZeneca

CHICAGO—Long-term use of dual antiplatelet therapy (DAPT) can benefit patients with a history of myocardial infarction (MI) and peripheral artery disease (PAD), according to data presented at the American College of Cardiology’s 65th Annual Scientific Session.

The data were from a subanalysis of the PEGASUS-TIMI 54 trial, in which researchers evaluated long-term use of aspirin, with or without the antiplatelet agent ticagrelor, in patients with a history of MI and at least 1 additional risk factor for thrombotic cardiovascular (CV) events.

The analysis suggested that, in stable patients with a history of MI, concomitant PAD is associated with a higher risk of major adverse cardiac events (MACE).

However, long-term DAPT with ticagrelor and aspirin can reduce the incidence of MACE in these patients, when compared to aspirin plus a placebo.

These results were presented as abstract 907-04 and simultaneously published in the Journal of American College of Cardiology. The trial was sponsored by AstraZeneca, the company developing ticagrelor.

Patients in the PEGASUS-TIMI 54 trial were randomized to receive aspirin plus twice-daily doses of ticagrelor at 90 mg, ticagrelor at 60 mg, or placebo.

The study’s primary efficacy endpoint was the incidence of MACE, which was defined as a composite of CV death, MI, or stroke.

The subanalysis showed that the 1143 patients with a prior MI and PAD had a higher incidence of MACE at 3 years than patients without PAD—19.3% and 8.4%, respectively (P<0.001).

The increased risk of MACE in patients with PAD persisted after the researchers adjusted for differences in patient characteristics at baseline. The hazard ratio (HR) was 1.60 (95% CI 1.20-2.13, P=0.0013).

Patients with PAD had a higher risk of CV death (HR 1.84, 95% CI 1.16-2.94, P=0.0102), stroke (HR 2.31, 95% CI 1.26–4.25, P=0.0071), and mortality (HR 2.05, 95% CI 1.43-2.94, P<0.001) than patients without PAD.

Patients who received DAPT (ticagrelor at either dose plus aspirin) had a lower risk of MACE at 3 years than patients who received placebo plus aspirin. This was true for patients with PAD (HR 0.75, 95% CI 0.55-1.01) and without it (HR 0.86, 95% CI 0.77-0.96, P-interaction=0.41).

However, because of their higher absolute risk of MACE, patients with PAD had a greater absolute risk reduction (4.1%) than patients without PAD.

The risk of TIMI major bleeding was not significantly higher in patients with PAD than in those without it (HR 1.57, 95% CI 0.47-5.22, P=0.46).

For patients with PAD, TIMI major bleeding occurred more frequently with ticagrelor at 90 mg plus aspirin than with placebo plus aspirin (HR 1.46, 95% CI 0.39-5.43, P=0.57) and with ticagrelor at 60 mg plus aspirin than with placebo plus aspirin (HR 1.18, 95% CI 0.29-4.70, P=0.82), though the differences were not significant.

“Patients with prior MI and PAD are at further heightened risk of ischemic events relative to patients with prior MI and no PAD, even when accounting for other risk factors,” said study investigator Marc Bonaca, MD, of Brigham and Women’s Hospital in Boston, Massachusetts.

“Because of their heightened ischemic risk, patients in the subgroup analysis with a prior MI and PAD appear to have a higher absolute risk reduction with ticagrelor than those without. These findings may be helpful to clinicians in identifying patients with prior MI who they feel could benefit from prolonged therapy with ticagrelor.”

Ticagrelor tablets

Photo courtesy of AstraZeneca

CHICAGO—Long-term use of dual antiplatelet therapy (DAPT) can benefit patients with a history of myocardial infarction (MI) and peripheral artery disease (PAD), according to data presented at the American College of Cardiology’s 65th Annual Scientific Session.

The data were from a subanalysis of the PEGASUS-TIMI 54 trial, in which researchers evaluated long-term use of aspirin, with or without the antiplatelet agent ticagrelor, in patients with a history of MI and at least 1 additional risk factor for thrombotic cardiovascular (CV) events.

The analysis suggested that, in stable patients with a history of MI, concomitant PAD is associated with a higher risk of major adverse cardiac events (MACE).

However, long-term DAPT with ticagrelor and aspirin can reduce the incidence of MACE in these patients, when compared to aspirin plus a placebo.

These results were presented as abstract 907-04 and simultaneously published in the Journal of American College of Cardiology. The trial was sponsored by AstraZeneca, the company developing ticagrelor.

Patients in the PEGASUS-TIMI 54 trial were randomized to receive aspirin plus twice-daily doses of ticagrelor at 90 mg, ticagrelor at 60 mg, or placebo.

The study’s primary efficacy endpoint was the incidence of MACE, which was defined as a composite of CV death, MI, or stroke.

The subanalysis showed that the 1143 patients with a prior MI and PAD had a higher incidence of MACE at 3 years than patients without PAD—19.3% and 8.4%, respectively (P<0.001).

The increased risk of MACE in patients with PAD persisted after the researchers adjusted for differences in patient characteristics at baseline. The hazard ratio (HR) was 1.60 (95% CI 1.20-2.13, P=0.0013).

Patients with PAD had a higher risk of CV death (HR 1.84, 95% CI 1.16-2.94, P=0.0102), stroke (HR 2.31, 95% CI 1.26–4.25, P=0.0071), and mortality (HR 2.05, 95% CI 1.43-2.94, P<0.001) than patients without PAD.

Patients who received DAPT (ticagrelor at either dose plus aspirin) had a lower risk of MACE at 3 years than patients who received placebo plus aspirin. This was true for patients with PAD (HR 0.75, 95% CI 0.55-1.01) and without it (HR 0.86, 95% CI 0.77-0.96, P-interaction=0.41).

However, because of their higher absolute risk of MACE, patients with PAD had a greater absolute risk reduction (4.1%) than patients without PAD.

The risk of TIMI major bleeding was not significantly higher in patients with PAD than in those without it (HR 1.57, 95% CI 0.47-5.22, P=0.46).

For patients with PAD, TIMI major bleeding occurred more frequently with ticagrelor at 90 mg plus aspirin than with placebo plus aspirin (HR 1.46, 95% CI 0.39-5.43, P=0.57) and with ticagrelor at 60 mg plus aspirin than with placebo plus aspirin (HR 1.18, 95% CI 0.29-4.70, P=0.82), though the differences were not significant.

“Patients with prior MI and PAD are at further heightened risk of ischemic events relative to patients with prior MI and no PAD, even when accounting for other risk factors,” said study investigator Marc Bonaca, MD, of Brigham and Women’s Hospital in Boston, Massachusetts.

“Because of their heightened ischemic risk, patients in the subgroup analysis with a prior MI and PAD appear to have a higher absolute risk reduction with ticagrelor than those without. These findings may be helpful to clinicians in identifying patients with prior MI who they feel could benefit from prolonged therapy with ticagrelor.”

Ticagrelor tablets

Photo courtesy of AstraZeneca

CHICAGO—Long-term use of dual antiplatelet therapy (DAPT) can benefit patients with a history of myocardial infarction (MI) and peripheral artery disease (PAD), according to data presented at the American College of Cardiology’s 65th Annual Scientific Session.

The data were from a subanalysis of the PEGASUS-TIMI 54 trial, in which researchers evaluated long-term use of aspirin, with or without the antiplatelet agent ticagrelor, in patients with a history of MI and at least 1 additional risk factor for thrombotic cardiovascular (CV) events.

The analysis suggested that, in stable patients with a history of MI, concomitant PAD is associated with a higher risk of major adverse cardiac events (MACE).

However, long-term DAPT with ticagrelor and aspirin can reduce the incidence of MACE in these patients, when compared to aspirin plus a placebo.

These results were presented as abstract 907-04 and simultaneously published in the Journal of American College of Cardiology. The trial was sponsored by AstraZeneca, the company developing ticagrelor.

Patients in the PEGASUS-TIMI 54 trial were randomized to receive aspirin plus twice-daily doses of ticagrelor at 90 mg, ticagrelor at 60 mg, or placebo.

The study’s primary efficacy endpoint was the incidence of MACE, which was defined as a composite of CV death, MI, or stroke.

The subanalysis showed that the 1143 patients with a prior MI and PAD had a higher incidence of MACE at 3 years than patients without PAD—19.3% and 8.4%, respectively (P<0.001).

The increased risk of MACE in patients with PAD persisted after the researchers adjusted for differences in patient characteristics at baseline. The hazard ratio (HR) was 1.60 (95% CI 1.20-2.13, P=0.0013).

Patients with PAD had a higher risk of CV death (HR 1.84, 95% CI 1.16-2.94, P=0.0102), stroke (HR 2.31, 95% CI 1.26–4.25, P=0.0071), and mortality (HR 2.05, 95% CI 1.43-2.94, P<0.001) than patients without PAD.

Patients who received DAPT (ticagrelor at either dose plus aspirin) had a lower risk of MACE at 3 years than patients who received placebo plus aspirin. This was true for patients with PAD (HR 0.75, 95% CI 0.55-1.01) and without it (HR 0.86, 95% CI 0.77-0.96, P-interaction=0.41).

However, because of their higher absolute risk of MACE, patients with PAD had a greater absolute risk reduction (4.1%) than patients without PAD.

The risk of TIMI major bleeding was not significantly higher in patients with PAD than in those without it (HR 1.57, 95% CI 0.47-5.22, P=0.46).

For patients with PAD, TIMI major bleeding occurred more frequently with ticagrelor at 90 mg plus aspirin than with placebo plus aspirin (HR 1.46, 95% CI 0.39-5.43, P=0.57) and with ticagrelor at 60 mg plus aspirin than with placebo plus aspirin (HR 1.18, 95% CI 0.29-4.70, P=0.82), though the differences were not significant.

“Patients with prior MI and PAD are at further heightened risk of ischemic events relative to patients with prior MI and no PAD, even when accounting for other risk factors,” said study investigator Marc Bonaca, MD, of Brigham and Women’s Hospital in Boston, Massachusetts.

“Because of their heightened ischemic risk, patients in the subgroup analysis with a prior MI and PAD appear to have a higher absolute risk reduction with ticagrelor than those without. These findings may be helpful to clinicians in identifying patients with prior MI who they feel could benefit from prolonged therapy with ticagrelor.”