Reduction in Ischemic Events With Ticagrelor in Diabetic Patients With Prior Myocardial Infarction in PEGASUS–TIMI 54

• Published in: Journal of the American College of Cardiology Vol. 67; no. 23; pp. 2732 - 2740
• Main Authors: Bhatt, Deepak L., Bonaca, Marc P., Bansilal, Sameer, Angiolillo, Dominick J., Cohen, Marc, Storey, Robert F., Im, Kyungah, Murphy, Sabina A., Held, Peter, Braunwald, Eugene, Sabatine, Marc S., Steg, Ph. Gabriel
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 14.06.2016; Elsevier Limited
• Subjects: acute coronary syndrome; Adenosine - administration & dosage; Adenosine - adverse effects; Adenosine - analogs & derivatives; Aged; Aspirin; Cardiology; Cardiovascular; Cardiovascular disease; Confidence intervals; Coronary Disease - mortality; Coronary vessels; Diabetes; Diabetes Mellitus - epidemiology; Dose-Response Relationship, Drug; dual antiplatelet therapy; Female; Heart attacks; Heart surgery; Hemorrhage - chemically induced; Hemorrhage - epidemiology; Humans; Hypertension; Male; Middle Aged; Mortality; myocardial infarction; Myocardial Infarction - epidemiology; Myocardial Infarction - prevention & control; platelets; Purinergic P2Y Receptor Antagonists - administration & dosage; Purinergic P2Y Receptor Antagonists - adverse effects; Secondary Prevention; Stroke; Stroke - epidemiology; Stroke - prevention & control; dual antiplatelet therapy; acute coronary syndrome; MACE; CI; TIMI; myocardial infarction; HR; MI; platelets; major adverse cardiovascular event(s); Thrombolysis In Myocardial Infarction; hazard ratio; confidence interval
• ISSN: 0735-1097; 1558-3597; 1558-3597
• DOI: 10.1016/j.jacc.2016.03.529

Patients with diabetes appear to be at elevated risk of atherothrombotic events. The purpose of this study was to determine the effect of antiplatelet therapy with ticagrelor on recurrent ischemic events in patients with diabetes and prior myocardial infarction (MI). We examined the subgroups of patients with diabetes (n = 6,806) and without diabetes (n = 14,355) from 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), in which 21,162 patients with a history of MI 1 to 3 years prior and with additional risk factors were randomized to ticagrelor (90 or 60 mg twice daily) or placebo. Patients were followed for a median of 33 months. The primary efficacy endpoint was major adverse cardiovascular events (MACE) (cardiovascular death, MI, stroke) and the primary safety endpoint was TIMI (Thrombolysis In Myocardial Infarction) major bleeding. The relative risk reduction in MACE with ticagrelor was consistent for the pooled doses versus placebo in patients with diabetes (hazard ratio [HR]: 0.84; 95% confidence interval [CI]: 0.72 to 0.99; p = 0.035) and without diabetes (HR: 0.84; 95% CI: 0.74 to 0.96; p = 0.013; p interaction = 0.99). As patients with diabetes were at higher risk of MACE, the absolute risk reduction tended to be greater in patients with versus without diabetes (1.5% vs. 1.1%, with corresponding 3-year number needed to treat of 67 vs. 91). In patients with diabetes requiring pharmacological therapy (n = 5,960), the absolute risk reduction was 1.9% with a 3-year number needed to treat of 53. Additionally, in patients with diabetes, ticagrelor reduced cardiovascular death by 22% and coronary heart disease death by 34%. Similar to patients without diabetes, there was increased TIMI major bleeding in patients with diabetes (HR: 2.56; 95% CI: 1.52 to 4.33; p = 0.0004). In patients with diabetes with prior MI, adding ticagrelor to aspirin significantly reduces the risk of recurrent ischemic events, including cardiovascular and coronary heart disease death. (Prevention of Cardiovascular Events in Patients With Prior Heart Attack Using Ticagrelor Compared to Placebo on a Background of Aspirin [PEGASUS]; NCT01225562)