The activated platelet is central to development of ischemic cardiovascular events. Guidelines recommend treatment with a P2Y12 receptor antagonist for 1-year after myocardial infarction (MI) to reduce the risk of recurrent events.\u00a0 The PEGASUS trial sought to determine the impact of using the P2Y12 antagonist ticagrelor as part of long-term therapy after MI.\u00a0 In this trial, a total of 21,162 clinically stable patients with a MI in the prior 1 to 3 years (median 18 months) were randomized in a 1:1:1 fashion to either placebo, ticagrelor 90mg twice daily, or ticagrelor 60mg twice daily.\u00a0 All patients remained on aspirin and standard secondary prevention as tolerated.\u00a0 Follow up was for a median of 33 months with the primary outcome being a composite of cardiovascular death, myocardial infarction, or stroke and the primary safety end-point of bleeding.\u00a0 Both doses of ticagrelor led to significant reductions in the primary end-point (HR for 90mg dosing 0.85; 95% CI, 0.75 to 0.96; P=0.008, and HR for 60mg dosing 0.84; 95% CI, 0.74 to 0.95; P=0.004) primarily driven by a reduction in recurrent myocardial infarction.\u00a0 Rates of major bleeding were significantly higher with both doses of ticagrelor (~ 2.5%) compared with placebo (~1.0%) (P<0.001).<\/p>\n
Conclusions<\/strong><\/p>\n Among patients with prior MI, long-term antiplatelet therapy with the P2Y12 inhibitor ticagrelor in addition to aspirin reduces recurrent ischemic events.\u00a0 This finding is independent of the consideration dual-antiplatelet therapy duration after coronary stenting. Given prior a post-hoc analysis that suggested benefit of clopidogrel in similar patient populations, questions remain as to how the choice of P2Y12 inhibitor impacts patient outcomes.<\/p>\n Written by Hussain Contractor and Steven Bradley<\/p>\n