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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\u003Cp id=\u0022p-1\u0022\u003EThe PEGASUS-TIMI 54 trial demonstrated that continuing treatment with ticagrelor after 1 year following myocardial infarction protected patients from ischemic events and provided a more robust risk reduction compared to reinitiation in stable patients on aspirin monotherapy. Patients who were treated with only aspirin for \u0026gt;\u20051year after myocardial infarction did not derive any benefit from reinitiation of P2Y\u003Csub\u003E12\u003C\/sub\u003E inhibitor therapy and had an increased risk of bleeding.\u003C\/p\u003E\u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003Ecardiology \u0026amp; cardiovascular medicine clinical trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Emyocardial infarction\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EMACE\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EPEGASUS-TIMI 54\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EP2Y\u003Csub\u003E12\u003C\/sub\u003E inhibitors\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Eticagrelor\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ETIMI bleeding\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\u003Cp id=\u0022p-2\u0022\u003EThe PEGASUS-TIMI 54 trial evaluated the efficacy and safety of ticagrelor, a P2Y\u003Csub\u003E12\u003C\/sub\u003E receptor antagonist, in 21\u2005162 patients who had a myocardial infarction (MI) event 1 to 3 years earlier. Patients were randomly assigned to treatment with ticagrelor 90 or 60 mg BID or placebo; all patients received aspirin. The primary efficacy end point was the composite of cardiovascular (CV) death, MI, or stroke at a median 33 months of follow-up. The primary safety end point was TIMI major bleeding. The investigators reported that both ticagrelor doses significantly reduced the rate of the composite end point compared with placebo [Bonaca MP et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E. 2015].\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EMarc P. Bonaca, MD, Brigham and Women\u2019s Hospital, Boston, Massachusetts, USA, presented the results of a subanalysis of the PEGASUS-TIMI 54 trial that assessed the effect of ticagrelor on reducing atherothrombotic events in post-MI patients, based on the time from withdrawal of their previous P2Y\u003Csub\u003E12\u003C\/sub\u003E inhibitor therapy. The investigators hypothesized that patients withdrawn from P2Y\u003Csub\u003E12\u003C\/sub\u003E inhibition at or shortly prior to randomization would have a relatively high ischemic risk compared with patients who had survived event free on aspirin therapy alone for a prolonged period and therefore would have a more robust reduction in ischemic risk with ticagrelor therapy.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EThe patients were stratified at the time of randomization according to time from P2Y\u003Csub\u003E12\u003C\/sub\u003E inhibitor withdrawal: \u2264\u200530 days (n\u2005=\u20057181), \u0026gt;\u200530 days to 1 year (n\u2005=\u20056501), and \u0026gt;\u20051 year (n\u2005=\u20055079). Patients taking placebo who recently stopped P2Y\u003Csub\u003E12\u003C\/sub\u003E inhibition (\u2264\u200530 days) had a higher risk for major adverse cardiac events (9.9%; HR, 1.47; 95% CI, 1.12 to 1.93), as did those who had stopped therapy 30 days to \u2264\u20051 year previously (8.7%; HR, 1.28; 95% CI, 0.98 to 1.67), compared with patients who had stopped therapy \u0026gt;\u20051 year previously (6.9%; \u003Cem\u003EP\u003C\/em\u003E\u003Csub\u003Etrend\u003C\/sub\u003E\u2005=\u2005.0097).\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EThe benefit of ticagrelor treatment was greatest among patients randomized to ticagrelor within 30 days of P2Y\u003Csub\u003E12\u003C\/sub\u003E inhibitor withdrawal even if MI was \u0026gt;\u20052 years ago, with a 27% risk reduction for CV death, myocardial infarction, or stroke (\u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E). Patients who started ticagrelor \u0026gt;\u200530 days to 1 year from P2Y\u003Csub\u003E12\u003C\/sub\u003E withdrawal had a 14% reduced risk, while those who started ticagrelor \u0026gt;\u20051 year after P2Y\u003Csub\u003E12\u003C\/sub\u003E withdrawal derived no benefit.\u003C\/p\u003E\u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/15\/28\/20\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Reduction in Major Adverse Cardiac Events With Ticagrelor by Time From P2Y12 Inhibitor WithdrawalReproduced with permission from MP Bonaca, MD.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1778088459\u0022 data-figure-caption=\u0022\u0026amp;lt;div xmlns=\u0026amp;quot;http:\/\/www.w3.org\/1999\/xhtml\u0026amp;quot;\u0026amp;gt;Reduction in Major Adverse Cardiac Events With Ticagrelor by Time From P2Y\u0026amp;lt;sub\u0026amp;gt;12\u0026amp;lt;\/sub\u0026amp;gt; Inhibitor WithdrawalReproduced with permission from MP Bonaca, MD.\u0026amp;lt;\/div\u0026amp;gt;\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/15\/28\/20\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/15\/28\/20\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/15\/28\/20\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/16976\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \u003Cp id=\u0022p-6\u0022 class=\u0022first-child\u0022\u003EReduction in Major Adverse Cardiac Events With Ticagrelor by Time From P2Y\u003Csub\u003E12\u003C\/sub\u003E Inhibitor Withdrawal\u003C\/p\u003E\u003Cp id=\u0022p-7\u0022\u003EReproduced with permission from MP Bonaca, MD.\u003C\/p\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-8\u0022\u003EAt 3 years, patients treated with ticagrelor within 30 days of randomization had a significantly lower risk of ischemic events vs those treated with placebo (ticagrelor 90 mg, \u003Cem\u003EP\u003C\/em\u003E\u2005=\u2005.0009; ticagrelor 60 mg, \u003Cem\u003EP\u003C\/em\u003E\u2005=\u2005.0064; \u003Ca id=\u0022xref-fig-2-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F2\u0022\u003EFigure 2\u003C\/a\u003E).\u003C\/p\u003E\u003Cdiv id=\u0022F2\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/15\/28\/20\/F2.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Major Adverse Cardiac Events With Ticagrelor in Patients With P2Y12 Inhibitor Withdrawal \u0026#x2264;\u0026#x2005;30 Days From RandomizationCVD, cardiovascular death; MI, myocardial infarction; NNT, number needed to treat.Reproduced with permission from MP Bonaca, MD.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1778088459\u0022 data-figure-caption=\u0022Major Adverse Cardiac Events With Ticagrelor in Patients With P2Y12 Inhibitor Withdrawal \u0026#x2264;\u0026#x2005;30 Days From RandomizationCVD, cardiovascular death; MI, myocardial infarction; NNT, number needed to treat.Reproduced with permission from MP Bonaca, MD.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 2.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/15\/28\/20\/F2.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/15\/28\/20\/F2.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 2.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/15\/28\/20\/F2.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/16977\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 2.\u003C\/span\u003E \u003Cp id=\u0022p-9\u0022 class=\u0022first-child\u0022\u003EMajor Adverse Cardiac Events With Ticagrelor in Patients With P2Y12 Inhibitor Withdrawal \u2264\u200530 Days From Randomization\u003C\/p\u003E\u003Cp id=\u0022p-10\u0022\u003ECVD, cardiovascular death; MI, myocardial infarction; NNT, number needed to treat.\u003C\/p\u003E\u003Cp id=\u0022p-11\u0022\u003EReproduced with permission from MP Bonaca, MD.\u003C\/p\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-12\u0022\u003EThe TIMI major bleeding rate was significantly higher with ticagrelor compared with placebo at 3 years.\u003C\/p\u003E\u003Cp id=\u0022p-13\u0022\u003EThese results showed that continuing P2Y\u003Csub\u003E12\u003C\/sub\u003E inhibition beyond 1 year after MI provided a robust benefit for reducing cardiac events. Reinitiation of P2Y\u003Csub\u003E12\u003C\/sub\u003E inhibition in patients who had survived without ischemic events on aspirin alone for \u0026gt;\u20051 year did not appear to provide any benefit and increased the risk of bleeding. Ongoing research using clinical, biochemical, and genetic factors may provide further prospective data for defining the optimal patient populations for long-term therapy.\u003C\/p\u003E\u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2015 SAGE Publications\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/15\/28\/20.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzl4sp\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzl4sp\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}