Long-Term Use of Ticagrelor in Patients

with Prior Myocardial Infarction

Background
infarction global problem
U.S 3 million have a history of M.I
M.I patients risk for recurrent
ischemic events derive particular
benefit from intensive secondary
prevention
Aspirin + P2Y12 receptor antagonist
reduce further the risk of ischemic
events in the 1st year after an acute
coronary syndrome
Myocardial

Ticagrelor
Potent
Reversibly

binding
Direct-acting P2Y12 receptor
antagonist

After an acute coronary

syndrome
Reduced the rate of
major adverse
cardiovascular event
(including
cardiovascular death)

Purpose
to test the hypothesis that
long-term therapy with ticagrelor
+ low-dose aspirin reduces the
risk of major adverse
cardiovascular events among
stable patients with a history of
myocardial infarction
Ticagrelor 90 mg 2dd
60 mg 2dd
Trial

Study Design
Randomized
Double

blind
Placebo-controlled clinical trial

Eligible Patients
Had a spontaneous M.I 1-3 years before
enrollment
At least 50 y.o
Had 1 of additional high risk features :
Age 65
DM requiring medication
2nd prior spontaneous M.I
Multivessel C.A.D or chronic renal dysfunction
(creatinin 60 ml/min)

Ineligible patients
Was planned use of a P2Y12 receptor
antagonist, dypiridamole, cilostazol, or
antocoagulant therapy
Had a bleeding disorder or a history of an
ischemic stroke or intracranial bleeding
Central nervous system tumor
Intracranial vascular abnormality
Had GI bleeding within the previous 6
months
Major surgery within the previous 30
days

Randomization and Study

Treatment
Eligible

patients were randomly

assigned in 1:1:1 ratio within each
study site to receive ticagrelor orally :
90 mg 2dd
60 mg 2dd
Placebo

Randomization was performed with

the use of a central computerized
telephone or web-based system
Assignment double blind

End Points
Primary
efficacy
end points
Composite of
:
Cardiovascul
ar death
Myocardial
infarction
Stroke

Secondar
y end
points
Cardiovascul
ar death

Death from
any cause

Additional
end points
Urgent
coronary
revasculariza
tion
Hospitalizatio
n for
unstable
angina
Transient
ischemic
attack

Primary
safety
end
point

Thrombolysis
in myocardial
infarction
(TIMI) major
bleeding

Other
safety
end
point

Intracranial
hemorrhage

Fatal
bleeding

Conclusion
The addition of ticagrelor, at a
dose of 90 mg 2x daily or 60 mg
2x daily, to low dose aspirin
reduced the risk of cardiovascular
death, myocardial infarction, or
stroke and increased in the risk of
TIMI major bleeding among
patients who had had a
myocardial infarction 1-3 years
earlier.