Marc Petter Bonaca, MD, MPH & Investigator in the TIMI Study Group discusses efficacy and safety of ticagrelor as long-term secondary prevention in patients with prior myocardial infarction and peripheral artery disease at the American College of Cardiology 65th Annual Scientific Session & Expo (ACC.16).
Pegasus tv 54 demonstrated that long-term secondary prevention with takagi cardiovascular death mi or stroke in patients with the prior myocardial infarction now as we look at the data we’re trying to understand the efficacy and safety of long-term secondary prevention in important subgroups and one of those subgroups are patients with peripheral artery disease
It’s important that this population in pegasus is a population of so-called poly vascular disease they’ve had both a prior myocardial infarction and peripheral artery disease and we know that those patients are heightened risk of ischemic events including limb ischemic events heart attacks mortality and bleeding it’s always important we felt it was important
To understand the efficacy and safety of therapy in that population the primary results of the analysis and the pa d sub group were that patients with peripheral artery disease were at higher risk of cardiovascular events so mi stroke and cardiovascular death as well as all cause mortality and limb ischaemia events relative to my patients without pa d and that
Relationship with risk was preserved even after we adjusted for differences in baseline between the two groups in terms of the efficacy and safety of to cadwal or we found that the efficacy was similar and those with and without pa d in terms of the relative risk reduction but because the pa d patients were such a high absolute risk that translated into a robust
Absolute risk reduction of over four percent when you look at the doses combined or with the 60 milligram dose over five percent and a very low number needed to treat in addition we found that the bleeding signal for tech aguilar was similar for patients without and with baad there was no difference and we saw in an exploratory endpoint that there was a reduction
In adverse limb events with a category which was an exploratory endpoint but something where we saw sort of reduction pegasus looked at two doses laura one was the ninety milligram dose that had been shown efficacious in the acs trial play-doh and one was a lower dose 60 milligrams which was thought to potentially have an optimal blend of efficacy and safety for
Long-term exposure long term secondary prevention overall both doses reduced events into a very similar extent versus placebo in the trial we saw no heterogeneity for either dose based on the pa depopulation but in you look at the actual endpoints you see that the 60 milligram dose actually has significant reductions for cardiovascular death and mortality and a
More robust absolute risk reduction and relative risk reduction and whether there are truly differences between the doses we didn’t test that in the paper we have seen that pattern throughout the trial the 60 milligram dose look particularly attractive from a risk-benefit profile and in perhaps because it’s a better tolerated dose there was better adherence with
The 60 milligram dose but overall it’s very reassuring because that’s the date that dose that’s labeled for use i think the take-home message is that the prior mi population if clinicians are thinking of which populations are going to get a robust benefit from long-term tech a girl or therapy that i would say patients with peripheral artery disease and prior mi
It’s one of those populations that will derive a very robust risk reduction
Transcribed from video
Patients with PAD, prior MI benefit greatly from long-term ticagrelor therapy By MDLinx
