Ticagrelor boosts aspirin in patients with diabetes, prior PCI, stable CAD

The addition of ticagrelor to aspirin leads to better outcomes in patients with diabetes, previous percutaneous coronary intervention (PCI) and stable coronary artery disease (CAD), a recent study has found. The combination may also increase the risk of major bleeding, however.

Researchers randomly assigned 11,154 patients with previous PCI to receive either ticagrelor or placebo. The primary efficacy outcome was the composite of cardiovascular death, stroke or myocardial infarction.

Over a median follow-up of 3.3 years, 404 episodes (7.3 percent) of the primary outcome were reported in the ticagrelor group. This was significantly lower than that in the placebo group, in which 480 such episodes (8.6 percent) were documented (hazard ratio [HR], 0.85, 95 percent CI, 0.74–0.97; p=0.013).

In a separate analysis involving patients with no prior PCI, add-on ticagrelor did not yield such a benefit (8.2 percent vs 8.4 percent; HR, 0.98. 0.84–1.14; p=0.76).

The occurrence of ST-elevation myocardial infarction was also significantly suppressed in those who received ticagrelor (0.3 percent vs 0.9 percent; HR, 0.32, 0.18–0.55; p<0.0001). The same was true for another composite endpoint consisting of coronary, cerebral and peripheral ischaemic events.

On the other hand, major bleeding, according to the Thrombolysis in Myocardial Infarction (TIMI; HR, 2.03, 1.48–2.76; p<0.0001) and Platelet Inhibition and Patient Outcomes (PLATO; HR, 2.22, 1.72–2.86; p<0.0001) criteria, was significantly increased in those who were given ticagrelor.

This effect remained true even in those without a history of PCI (TIMI: HR, 2.79, 1.91–4.06; p<0.0001; PLATO: HR, 2.72, 1.99–3.72; p<0.0001).