Definition at patent would stop coronary artery disease decisis and the awaited mini – who had not had a car deal in fashion or structure or that high which for cardiovascular had been guenter adding two got together to spring in profit all scum in this population in the nuclear so the famous charles actually the largest trial of diabetes done to date over 19,000
Patients randomized to either a tight angle or placebo on top of low-dose aspirin specifically these were patients with diabetes and stable chronic coronary artery disease patients with prior myocardial infarction or stroke were excluded so these were patients who didn’t have an indication for that or a randomized to take calculus ii bond followed for a median of
Over a little bit over three and a half years what we found in the primary composite endpoint of cardiovascular death mi or stroke was a significant 10% relative risk reduction and we didn’t really just stop there there was of course an increase in major bleeding as one would anticipate for a potent antiplatelet versus a placebo but we wanted to see what patients
Within the overall large simas file might be the ones who would really recommend use of either reinitiating or continuing aspirin ty categorical antiplatelet therapy in general and what we found was that in the large pre-specified subgroup of patients with the previous percutaneous coronary intervention themis pci i there was a 15% relative risk reduction that
Was statistically significant and a bleeding profile that was a bit better than in the patients without pca there was still an increase in major bleeding but no increases in fatal bleeding or inter-cranial bleeding are the most worrisome forms of bleeding so really what we’ve concluded then from cmas and in particulars themis pci is in that patient with diabetes
With apparently stable chronic coronary artery disease they are still at high risk for events like heart attack stroke amputation the addition of type category 2 low-dose aspirin can reduce those events but the physician does need to be careful to select patients that are low bleeding risk and in patients with a history of previous pci a good thing there is if
They’ve got a stent that means the fact though they’ve been exposed to dual antiplatelet therapy before presumably having bled and if that’s the case that they’re proven to be at low bleeding risk those are the sorts of patients were initially of titanic or an aspirin or continuation of current apt in that patient with diabetes might be considered i was wondering
If he could discuss for a minute how you formulated this exploratory endpoint of sort of the catastrophic event that seemed like it was a patient-centered outcome and what you found there in the in the overall population in the pci subgroup and sort of why you why you came to look at that endpoint and what it means great question so that was a pretty specified
Endpoint and really the idea there was to look at all the ischemic endpoints that might matter to a patient people with diabetes are at risk for myocardial infarction for st segment 1 st some elevation myocardial infarction ischemic stroke and we saw significant reductions and all those endpoints in the overall theme is trial and amputation and acute limb ischemia
Is not conventionally included in these sorts of composite endpoints in his cardiovascular files but from a patient perspective oftentimes that’s the worst thing that can think of happen and even more so than a heart attack you know losing a limb and what we found there was a significant reduction in that endpoint so when you lump it all together then there’s
A quite robust reduction in that mega composite of ischemic events which again from a patient’s perspective that’s what they need to weigh with their doctor the potential to reduce those sorts of important ischemic events versus the bleeding hazard that they might be exposed to so i think these sorts of decisions often do involve the discussion with the patient
And their tolerance for different side effects like bleeding obviously cost of medication enters that type of discussion but then the potential to prevent events like heart attack stroke and amputation metro in this random mrs. dolan bling trail we a signet pattern who were 15 years of age or older and who had stabbed coronary artery decisis and tap it to the
Avetis mohito to precise a turn the car gravel clues a spring espressivo plus a spring patent with previous module korea in fashion stroke will accrue set metal the primary efficacies out code blasts on composited of cardiovascular delete majolica in fashion or stroke the primary sisters who’s come was merger blending and athena’s be the trembles in melodical
In fashion prettily russell says parton underwent randomization the mundane fall oop goes permanent treatment discontinuous was more frightened with together the placebo the incidence of in chanak cardiovascular event was lower in dating trigger looked down in the placebo group resulted the incidence of exploring composited tablet of irreversible harm majolica
Infarction stroke fatah reading on internal emirati what as milling the general group on the placebo group conclusion in conclusion impotent with stab coronary artery decisis and the erratic with some storage majora chol information or store those or reciprocal upload explaining one lower incidence of a shammy cardiovascular having bad hindered incident a margin
Brennidon dos worships placebo plus a spring hi we’re here in paris the press already went to the tiles of the esc progress i fear what are the resource of the famous activist pci critical times so we will focus on tammy’s pcit miss dispenser randomized clinical trials evaluating the benefits of your playstation tv therapy with psychic girl oh and as parenthesis
Aspirin alone when you see the results you have a net clinical benefits with a combination of psychic roller and aspirin only with patients with a history of pci you have no benefits where there is noise – of pci because you have a reduction of ischemic events but an increase of major bleeding but for patients with an issue of pci we have a net clinical benefits
Of 1.5% that means that you reduce ischemic events with low risk of major bleeding for the over and the other group you have no clinical benefits so it’s quite clear for patients with shared a patients with pcr and low risk of bleeding you can use the dual antiplatelet therapy with ty cobb rollo and aspirin
Transcribed from video
Ticagrelor in patients with stable coronary disease and diabetes. By juan velasco
