Long-term ticagrelor for secondary prevention in patients with prior myocardial infarction and no history of coronary stenting: insights from PEGASUS-TIMI 54.
长期替格瑞洛用于先前心肌梗死且无冠状动脉支架置入史的患者的二级预防: 来自 PEGASUS-TIMI 的见解 54。
Antiplatelet drugs Dual antiplatelet therapy Medically managed Myocardial infarction Ticagrelor
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摘要

AIMS: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). 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.
METHODS AND RESULTS: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. A total of 4199 patients had no history of coronary stenting at baseline. The primary efficacy outcome (MACE) was the composite of cardiovascular death, MI, or stroke. Patients without history of coronary stenting had higher baseline risk of MACE [13.2% vs. 8.0%, adjusted hazard ratio (HR) 1.41, 95% confidence interval (CI) 1.15-1.73, in the placebo arm]. 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).
CONCLUSION:Long-term ticagrelor reduces thrombotic events in patients with prior MI regardless of whether they had prior coronary stenting. 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.
CLINICALTRIALS.GOV IDENTIFIER:NCT01225562.

译文

目的: PEGASUS-TIMI 54 表明,阿司匹林和替格瑞洛的长期双联抗血小板治疗 (DAPT) 降低了主要不良心血管事件 (MACE) 的风险,并可接受增加出血, 在既往有心肌梗死 (MI) 的患者中。虽然许多关于延长 DAPT 的讨论都集中在支架患者身上,但先前没有支架的心肌梗死患者是一个临床上重要的亚组。
方法和结果: 这是一项来自 54 PEGASUS-TIMI 的预先指定的分析,该分析将 21 162 名先前患有 MI (1-3 岁) 的患者以及其他高风险特征随机分为替格瑞洛 60 毫克、 90 毫克、或者除了阿司匹林,每天两次服用安慰剂。共有 4199 名患者在基线时没有冠状动脉支架置入史。主要疗效结果 (MACE) 是心血管死亡、心肌梗死或中风的综合结果。没有冠状动脉支架置入史的患者有更高的 MACE 基线风险 [13.2% vs.8.0%,校正风险比 (HR) 1.41,95% 置信区间 (CI) 1.15-1.73, 在安慰剂组]。在未使用替格瑞洛 (HR 0.82,95% CI 0.68-0.99) 和之前使用支架 (HR 0.85, 95% CI 0.75-0.96; 交互作用 P = 0.76)。
结论: 长期使用替格瑞洛可减少先前心肌梗死患者的血栓事件,无论他们是否有冠状动脉支架。这些数据强调了 DAPT 在预防自发性动脉粥样硬化血栓形成事件方面的益处,并表明即使高危患者没有接受支架治疗,也可以考虑长期使用替格瑞洛。
临床试验。政府标识符: nct01225562。

ticagrelor

心血管 急性冠状动脉综合征 药物
概述  :  

冠心病是一种猝死率高、危害严重的常见疾病,规范冠心病管理是改善预后、降低死亡率的关键,无论采取药物或介入治疗,抗血小板治疗均是冠心病管理的基石。双联抗血小板,即阿司匹林联合一种P2Y12受体拮抗剂是急性冠状动脉综合征(acute coronary syndromes, ACS)和(或)经皮冠状动脉介入(percutaneous coronary intervention, PCI)患者的标准治疗。替格瑞洛是一种新型强效P2Y12受体拮抗剂,多国、多中心、双盲随机对照的PLATO研究表明,替格

Ticagrelor

释义   n. 替格瑞洛

例句   It is ok to say that we are working on a revision of the guidelines that will address the appropriate use of ticagrelor, which should come out next year.

这其实没关系,我们正在修改指南,并将提出替格瑞洛的适当用法,预计该指南将于明年公布。  


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