Ticagrelor in patients with diabetes and stable coronary artery disease with a history of previous percutaneous coronary intervention (THEMIS-PCI): a phase 3, placebo-controlled, randomised trial


Por: Bhatt D.L., Steg P.G., Mehta S.R., Leiter L.A., Simon T., Fox K., Held C., Andersson M., Himmelmann A., Ridderstråle W., Chen J., Song Y., Diaz R., Goto S., James S.K., Ray K.K., Parkhomenko A.N., Kosiborod M.N., McGuire D.K., Harrington R.A., Santos V., Jain A., Lendel I., Russo M., Haught W.H., Bouza M., Gogia H., Kichura G., Kantaros L., Padron F., Passi R., Stone J., Pursley M., D'Urso M., Gardner T., Bennett J., Nour K., Saini S., Zhang W., Kumbhani D., Thomas D., Angiolillo D., Bertolet B., Roman-Miranda A., Black R., Manshadi R., Vaca C., Blanco A., Napoli M., Brabham D., Akyea-Djamson A., Desai P., Prasada S., Khaira A., Forgosh L., Lieber I., Umpierrez G., Singal D., Londono J., Fraser N., Ruiz J., Vega D., Rodriguez L., Brown C., Syed F., Aggarwala G., Eaves W., Gupta D., Avino D., Asfour W., Tonnessen G., Zhao X.-Q., Singh N., Brockmyre A., Lepor N., Shammas N., Blick D., Hearne S., Prodafikas J., Carell E., Izzo M., Karim A., Zakhary B., Atieh M., Leichter S., Meadows C., Hotchkiss D., Abu-Fadel M., Wiseman A., Bander J., Shah M., Ganim R., Sopko K., Khan M., Lloret R., Weirick T., Mehta R., Thadani U., Bhargava A., Moya J., Staniloae C., Guerra Y.D., Chhabra A., Kosmicki D., Shaheen W., Mohammed A., Bitters J.C., Pattanayak J., Javier J., Srivastava S., Phillips R., Al-Amin J., Lillestol M., Simpson P., Hazan L., Amin A., Shah G., Korpas D., Platt B., Dickert J., Puente O., Hiotis L., Doyle T., Rajan R., Meholick A., Gring C., Hage-Korban E., Feldman R., Colfer H., Butman S., Foster M., Hart T., Huling R., Eshaghian S., Quintana O., Cheung D., Handel F., Suh D., Gordon P., Pressman G., Bauer M., French W., Barettella M., Chatrathi S., Suresh D., Goldberg R., Huth M., Younis L., Rahman A., Mascolo R., Welch M., Suneja R., Shurmur S., Agaiby J., Jingo A., Johnston J., Beth M., Vlastaris A., Kemp S., Taheri H., Pereira E., Deyoung M., Hawa Z., Smith R., Galski T., Garas S., Reddy M., Sharma S., Hargrove J., Treasure C., Emerson R., Haddad T., Rohr K., Levinson L., Gaona R., Uretsky B., Maheshwari H., Lee D., Kinnaman S., Singal R., Geohas J., Gigliotti O., Raisinghani A., Khurana C., Hella B., Kelberman M., Voyce S., Singh S., Lo E., Singh P., Goodfellow R., Lorraine R., Turner T., Shanes J., Busch R., Broker R., Zaniewski M., Pounds K., Debs-Perez G., Ong S., Frandsen B., Fullington D., Jaffrani N., Khan A., Lee M., Pouzar J., Revtyak G., Gonzalez J., Nakhle S., Murillo A., Young D., Makam S., Syed M., Woolf K., Grena P., Alfata S., Mahal S., Hoffman D., Kizhakekuttu T., Deering J., Bhavsar J., Mikesell S., Wilson W., Wilson V., El S., Spinale F., Kannarkat V., Rao S., Hanson L., Bertsch J., Gonzalez-Ortiz E., Severino N., Willis J., Schock J., Bakhtari L., Gazmuri R., Ansari S., Hall J., Mehta A., Shealy N., Zarich S., Singh D., Vora K., Andrawis N., Molter D., Maron D., Cardona J., D'Agostino R., Arshad T., Samaan R., Jones D., Presser D., Heath J., Green S., Bittar G., Henry S., Korn D., Schmedtje J., Nadar V., Graham B., Labroo A., Clavijo L., Roseman H., Ledesma G., Rosen R., Dor I., Kirby W., Sutton J., Eder F., Iteld B., Gomez-Cortes J., Buchbinder M., Kasper J., Terrelonge A., Torres G., Jagielo T., Alvarez J., Handelsman Y., Guillen M., Richwine R., Lewy-Alterbaum L., Corder C., Arvind M., Bolshoun D., Mikhail M., Minton S., Alvarado O., Abbott J., Cauthen B., Welter R., Mintz R., Cox J., Quick A., Weiss M., Dy J., Zebrack J., Gandelman G., Hegde V., Silver M., DeGregorio M., Lawson W., Paa C., Bortnick A., Krolick M., Sotolongo R., Cheirif J., Kumar P., Jetty P., Patel A., Kruk M., Kobielusz-Gembala I., Rewerska B., Madrzejewski A., Milewski K., Cygler J., Petryka-Mazurkiewicz J., Jastrzebski W., Korecki J., Fil W., Prokopczuk J., Bochenek A., Wujkowski M., Witek R., Konczakowski P., Miekus P., Szczasny M., Musial W., Cymerman K., Lampart J., Mikosinski J., Szynal S., Fares I., Opolski G., Mazur S., Wozakowska-Kaplon B., Bijata-Bronisz R., Wierucki L., Losa B., Drelich G., Konieczny M., Starczewski P., Pawlowicz L., Jesionowski P., Jurowiecki J., Gniot J., Czyzycki M., Stania K., Kucharczyk-Bauman I., Busz-Papiez B., Karczmarczyk A., Sudnik W., Koszek A., Kolodziej P., Skwarna B., Jaramillo N., Jankowski M., Czochra W., Kinasz L., Miklaszewicz B., Stasinska T., Pluta W., Basiak M., Rusicka T., Niedbal-Yahfouf I., Popenda G., Korzeniak R., Mirek A., Mariankowski R., Wojnowski L., Korol M., Baszak J., Podolec P., Piesiewicz W., Zurakowski A., Luengas C., Skura M., Pilecki P., Majchrzak P., Krzyzagórska E., Drozd M., Kaczmarek B., Sliwinska T., Zelazowska K., Sztembis R., Landa K., Matyszczak-Toniak L., Strojek K., Piepiorka M., Malinowski R., Górska M., Stolarczyk-Sowa E., Romanowski L., Zinka E., Reszka Z., Skierkowska J., Uzunow A., Laskowska-Derlaga E., Puntus E., Kosmacheva E.D., Koziolova N., Pavlov P., Supryadkina T., Didenko Y., Kopylov P., Kazakov A., Aksentiev S., Vishneva E., Repin A., Smolenskaya O., Mantserova O., Khrustalev O., Privalova E., Konstantinov V., Boldueva S., Ezhov A., Chernyavsky A., Kamalov G., Galyavich A., Zubeeva G., Nechaeva G., Shustov S., Dzhaiani N., Treshkur T., Osokina N., Panov A., Shutemova E., Makukhin V., Kropotina T., Tsyba L., Karpov Y., Sizova J.M., Ballyuzek M., Tarasov N., Demchenko E., Barbarash O., Moiseev V., Markov V., Kuznetsov V., Viktorova I., Sergienko I., Ermoshkina L., Khasanov N., Khlevchuk T., Baglikov A., Shalaev S., Zonova E., Reznik E., Haisheva L., Morugova T., Lomakin N., Vishnevsky A., Shvarts Y., Magnitskaya O., Mikhailusova M., Pavlysh E., Libov I., Zateyschikova A., Kostenko V., Edin A., Khovaeva Y., Zakharov K., Stryuk R., Khirmanov V., Kanorskiy S., Yakushin S., Barabashkina A., Li H., Zhao Q., Zhang J., Ma J., He Y., Luo M., Zhang A., Zhang N., Chai Y., Ma G., Wang H., Liu Z., He L., Song Z., Dong X., Tao L., Li Z., Su X., Kong X., Niu H., Ge J., Luo Z., Huang W., Peng D., Yuan Z., Milanova M., Tenev D., Gogov A., Karageorgiev D., Kolchev T., Rusev N., Georgieva N., Kondov R., Rusinov V., Stanchev G., Konteva M., Dincheva A., Yaneva Z., Vatova R., Ilieva K., Runev N., Kolomanov B., Petrov I., Iliev N., Tisheva S., Chompalova B., Tokmakova M., Raev D., Byanov K., Markov D., Mihov L., Mihov A., Milcheva N., Minchev M., Mollov M., Borisov B., Tihchev T., Karakolev V., Dimov B., Georgiev S., Smilov L., Koo B.K., Ahn T., Hong S.J., Yoon J., Oh S.K., Jeong M.H., Kim D.-I., Chang K., Kim W., Hahn J.-Y., Cha K.S., Lee J.-H., Choi S.-W., Nam C.-W., Chae I.-H., Park Y.H., Tahk S.-J., Shin W.-Y., Chae J.-K., Kim B.J., Bae J.-W., Park W.J., Rha S.W., Choi Y.J., Hwang J.-Y., Park H.S., Baracioli L., Guimaraes F., Vasconcellos E., Saraiva J., Pereira A., Santos Q., Rossi P., Maia L., Madeira M., Pereira M., Botelho R., Reis G., Eliaschewitz F., Borges J., Nascimento C., Fortes J.A., de Souza W., Pimentel P., Hissa M., Franchetti M., Precoma D., Ortiz C., Hernandes M., Saporito W., dos Santos F.R., Kormann A., Neuenschwander F., Dutra O., Rassi N., Tanajura L., Souza J., Junior D.S., Leaes P., Forte A., Bonansea T.C., Marin J., Machado B., Cerqueira M.J., Silva F., Michalaros Y., Manenti E., Cercato C., Figueiredo E., Liu M.-E., Wang Y.-C., Lee T.-M., Fang C., Wu Y.-W., Ueng K.-C., Sheu H.-H., Lai W.T., Hsieh I.-C., Chen Z.-C., Lee M.-J., Chiang C., Shyu K.-G., Hsia C.-H., Mar G.-Y., Chan S.-H., Wu C.-C., Tseng W.-K., Chang K.-C., Yeh H.-I., Wang J.-H., Hou C., Sorokina I., Dolzhenko M., Horoshko O., Karpenko O., Rudenko L., Vakaliuk I., Kulyk A., Levchenko O., Prokhorov O., Reshotko D., Sorokivskyy M., Velichko N., Maslovskyi V., Teliatnikova Z., Dotsenko S., Krakhmalova O., Kraiz I., Zharinova V., Bula L., Kaydashev I., Molodtsov V., Rasputina L., Pidlisna V., Lysunets O., Kravchenko A., Glushko L., Khomazyuk T., Svyshchenko Y., Parkhomenko O., Mankovsky B., Abrahamovych O., Yagensky A., Stanislavchuk M., Vasilyeva L., Sokolova L., Sychov O., Tseluyko V., Kyrychenko I., Rishko M., Furkalo S., Gallo R., Bertrand O., Mehta S., Constance C., Sussex B., Zadra R., Kouz S., Chehayeb R., Pandey A., Dion D., Bailey G., Hill L., Ramanathan K., Dorsch M., Nanji A., Babapulle M., Montigny M., Gosselin G., Dehghani P., Rupka D., Le May M., Pichette F., St-Maurice F., Teefy P., Mansour S., Kassam S., Cheung S., Siega A.D., O'Keefe D., Sabbah E., Bell A., Chouinard G., Wong B., Miller M., Gaudet D., Lachance P., Bata I., Petrella R., Gossard D., Dumas R., Ing D., Boyrazian H., Bessoudo R., Huynh T.T., Hart R., Belle-Isle J., Shukla D., Kelly A., Mazza G., Cha J., Henein S., Frechette A., Vizel S., Liutkus J.F., O'Mahony M., Halperin F., Kooy J., Graham J., Bailey A., Wojcik R., Wilderman I., Turi T., Motyovszki Á., Merkely B., Király C., Andrássy P., Sárszegi Z., Fülöp T., Zilahi Z., Édes I., Papp A., Müller G., Czigány A., Zólyomi S., Korányi L., Takács J., Juhász F., Benczur B., Kancz S., Földi A., Nagy A.C., Bakai J., Greschik I., Püski L., Nagy L., Kirschner R., Kuchar R., Hajek P., Busak L., Michalik D., Matyasek I., Marusincova I., Kucera D., Jerabek O., Honkova M., Dedek V., Rihacek I., Kos P., Slaby J., Machkova M., Zidkova E., Elbl L., Grunfeldova H., Carda J., Mrozek V., Maly J., Milkovic R., Malecha J., Skalicka H., Oral I., Krcova E., Lisa L., Belohlavek J., Miklik R., Cermak O., Bednarova J., Peroutka Z., Spinar J., Wilke A., Appel K.-F., Taggeselle J., Förster A., Toursarkissian N., Schmidt E., Bott J., Al-Zoebi A., Hennig D., Fischer S., Schön N., Sauter J., Simonis G., Nischik R., Rieker W., Schenkenberger I., Behnke T., Klausmann G., Jeserich M., Trenk D., Weigmann I., Reuter H., Rummel R., von Münchhausen C., von Engelhardt C., Horibe E., Shibasaki T., Sato T., Kakuta T., Michishita I., Tan M., Ishiki R., Aoyama T., Higashiue S., Niijima Y., Idogaki A., Hasegawa T., Kiyosue A., Tomobuchi Y., Kawamitsu K., Kawasaki S., Hata Y., Fukui K., Seki K., Takenaka T., Abe M., Utsu N., Oono A., Mitsuo K., Sueyoshi A., Hirohata A., Tsujimoto M., Ueda O., Takase S., Suzuki M., Sakuragi S., Yamamoto F., Fujimoto N., Kakinoki S., Sugiura T., Sugino H., Nakamura T., Kadokami T., Uehara H., Ono M., Yokoya K., Koike A., Komatsu S., Sonoda M., Ueno H., Doi T., Takagi Y., Fujimoto K., Eki Y., Okubo M., Sasaki K., van Eck M., Ronner E., The S., van de Wal R., Nierop P., de Nooijer C., Werner H., Westendorp I., van der Zwaan C., Crijns H., Cornel J.H., Strikwerda S., Bos R., de Melker E., Kuijper A., Louwerenburg H., Plomp J., Dantzig J.-M., Prins F., van Kesteren H., Willems F., Amoroso G., Carnero G., Duronto E., Besada D., Chacon C., Zangroniz P., Solis S., Liberman A., Sernia V., Alvarisqueta A., Maffei L., Vilamajo O.G., García C., Sicer M., Muntaner J., Bordonava A., Albisu J., Zanini A., Rista L., Hominal M., Estrada J.N., Prado A., Gosparini D.M., Schiavi B., Castillo A.G., Ruíz J.G., Martinez G.R., López V.G., Rosas E.L., Lopez G.R., Cantu E.G., de los Ríos Ibarra M., Padilla F.P., Carrasco J.P., Carrillo L.V., García J.D., Askar A.N., Salinas C.A., Gamba M.A., Sanchez C.G., Cantú A.G., Sánchez R.V., Madrigal J.C., Urbano R.H., Romo A.Í., González Juanatey J.R., Racugno P., Fillat A.C., de la Torre Hernández J.M., Peláez J.A., Cortada J.B., Pavia P.G., Navarro M.J., Asenjo R.M., Díaz F.F., Peligero E.B., Manterola F.A., Ortiz A.F., Mediavilla García J.D., Ortuño F.M., Vera T.R., González A.S., Viñas J.A., Fernández Portales F.J., Mayordomo P.S., Ojeda F.B., Domínguez A.R., González R.S., Guerrero D.B., Ruiz Nodar J.M., Marimon X.G., Margáez J.G., Aguilera R.M., Díaz Fernández J.F., Zamorano Gómez J.L., González V.B., del Blanco B.G., Pérez I.P., Moreno M.R., Ereño A.R., García Lledó J.A., Prieto J., Villablanca A., Raffo C., Pincetti C., Conejeros C., Roman O., Rodriguez M., Varleta P., Goldberg C., Sandoval J., Arriagada G., Corbalan R., Leon L., Potthoff S., Cobos J., Figueroa C., Makotoko E., Fourie N., Burgess L., Nortje H., Theron R., Pillai P., Ranjith N., Trokis J., Pillay S., Reddy J., Nunkoo T., Kapp C., Urbach D., Distiller L., Horak A., van Zyl L., Coetzee K., Punt Z., Bayat J., Dawood S., Mitha I., Padayachee T., Hoosen F., Dalby A., Prabhavathi, Gowdaiah P., Mehta V., Chag M., Gadkari M., Ramamurthee K., Das A., Sawhney J.S., Banerjee S., Sathe P., Adhyapak S., Nguyen T., Pham V., Do H., Nguyen A., Nguyen H., Truong B., Jamil-Copley S., Lang C., Pell A., Zaman A., Storey R., Swanson N., Smith S., Sharman D., Braganza D., Hammond P., Moriarty A., Bain S., Pye M., Sharp A., Blagden M., Randeva H., Myhill T., Viswanathan G., Keeling P., Clifford P., Saxena M., Lyons K., McMurray J., Jaafar F., Murphy C., Cartwright S., Abouglila K., Antalik L., Krajci P., Urban M., Fazekas F., Pella D., Koleny D., Vykoukalova T., Macek V., Vinanska D., Jamriskova L., Such S., Fulop P., Farsky S., Bugan V., Strbova J., Micko K., Palka J., Jr., Sivak V., Kristensen D., Refsgaard J., Holmvang L., Dixen U., Nielsen H., Egstrup K., Jensen L.O., Sykulski R., Rasmussen O., Andries A., Luckow A., Nielsen G., Sørensen T., Wongvipaporn C., Chamnarnphol N., Srimahachota S., Sansanayudh N., Kuanprasert S., Tresukosol D., Sookananchai B., Kanadasi M., Ozcan T., Kucuk M., Ongen Z., Okuyan E., Arat A., Acikel S., Yalcin A., Guray U., Ceyhan C., Ozer N., Arslan S., Angerås O., Johnston N., Weiderman A.-C., Bandh S., Hansen O., Larnefeldt H., Kusiak D., Lindholm C.-J., Hedman A., Erlinge D., Curiac D., Lundman P., Zucconi-Mazzini R., Aladellie L., Jensen J., Verwerft J., Vrolix M., Faes D., Striekwold H., Sinnaeve P., Timmermans P., Guedes A., Delforge M., Nimmegeers J., Stammen F., Buysschaert I., Hoffer E., Hollanders G., Vervoort G., Coussement P., de Maeseneire S., Janssens L., Gravdal S.A., Risberg K., Gullestad L., Hofseth O.D., Nilsen D., Lappegård K.T., van den Heuvel C., Gibbs C., Khusrawi A., Arora S., Tomala T., Kjærnli T., Berg-Johansen J., Hagemeier R., Skjelvan G., Colquhoun D., Amerena J., Morbey C., Hammett C., Dart A., Lehman R., Hamilton A., Worthley M., Purnell P., Whelan A., MacIsaac R., Arya K., Linjawi S., Proietto J., Prasad L., Rodriguez A., Godoy A., Rodriguez V., Berrospi P., Chavez C., Negron S., Heredia J., Medina F., Manrique H., Cabrera W., Cordova F., Quinteros T., Haro J.M., Regalado S., Guitton J., Arbanil H., Pansieri M., Decoulx E., Goube P., de Labriolle A., Labeque J.N., Range G., Cottin Y., Montalescot G., Cayla G., Danchin N., Angoulvant D., Ferrario E., Elbaz M., Dubreuil O., Fontaine C., Sorbets E., Omer H., Al-Saif S., Al-Faleh H., Al-Shehri A., El-Amin O., Alshehri H., Bazari R., Hei P., Ying M., Chan M., Wong M., Ma R., Siu S.C., Tsang C.C., Ferrario M., Assanelli E., Senni M., Piatti P., Calabrò P., Urbinati S., Michisanti M., Varbella F., de Cosmo S., Trevisan R., Bellotti S., Di Pasquale G., Bongo A.S., Uguccioni M., Mannucci E., Mauro C., Ragonese M., Fresco C., Turturo M., Marcucci R., Lievano Triana M.J., Arana C., Accini J., Botero R., Muzyk-Osikowicz M., Dada F.T., Vallejo G.S., Manzur F., Isaza D., Molina D., Mesa J.G., Quintero A., Nyman K., Mäkelä J., Strand J., Nieminen S., Taurio J., Kuusela M., Valle T., Pietilä M., Kekki S., Strandberg T., Klutstein M., Greenberg G., Rozenman Y., Chorin E., Roguin A., Lewis B., Bashkin A., Tan E., Prado J.P., Ferrolino A., Babilonia N., Barbas B., Matiga G., Coching R.M., Drexel H., Brath H., Schnack C., Hanusch U., Fließer-Görzer E., Paulweber B., Ebenbichler C., Prager R., Huber K., Wolzt M., Auer J., Berger R., Schernthaner G.-H., Stanciulescu G., Creteanu M., Spiridon M., Dobreanu V., Vinereanu D., Iosipescu L.C., Istratoaie O., Coman I., Militaru C., Cinteza M., Sinnaeve P.R., Nicolau J.C., Kerr Saraiva J.F., Corbalán R., Widimský P., Kristensen S.D., Hartikainen J., Darius H., Tse H.F., Kiss R.G., Pais P., Lev E., de Luca L., Ramos López G.A., Kontny F., Babilonia N.A., Zateyshchikov D.A., Ruda M., Elamin O., Kovár F., Bueno H., Chiang C.-E., Parkhomenko A., Nguyen T.Q., Leonsson-Zachrisson M.

Publicada: 1 ene 2019
Categoría: Medicine (miscellaneous)

Resumen:
Background: Patients with stable coronary artery disease and diabetes with previous percutaneous coronary intervention (PCI), particularly those with previous stenting, are at high risk of ischaemic events. These patients are generally treated with aspirin. In this trial, we aimed to investigate if these patients would benefit from treatment with aspirin plus ticagrelor. Methods: The Effect of Ticagrelor on Health Outcomes in diabEtes Mellitus patients Intervention Study (THEMIS) was a phase 3 randomised, double-blinded, placebo-controlled trial, done in 1315 sites in 42 countries. Patients were eligible if 50 years or older, with type 2 diabetes, receiving anti-hyperglycaemic drugs for at least 6 months, with stable coronary artery disease, and one of three other mutually non-exclusive criteria: a history of previous PCI or of coronary artery bypass grafting, or documentation of angiographic stenosis of 50% or more in at least one coronary artery. Eligible patients were randomly assigned (1:1) to either ticagrelor or placebo, by use of an interactive voice-response or web-response system. The THEMIS-PCI trial comprised a prespecified subgroup of patients with previous PCI. The primary efficacy outcome was a composite of cardiovascular death, myocardial infarction, or stroke (measured in the intention-to-treat population). Findings: Between Feb 17, 2014, and May 24, 2016, 11 154 patients (58% of the overall THEMIS trial) with a history of previous PCI were enrolled in the THEMIS-PCI trial. Median follow-up was 3·3 years (IQR 2·8–3·8). In the previous PCI group, fewer patients receiving ticagrelor had a primary efficacy outcome event than in the placebo group (404 [7·3%] of 5558 vs 480 [8·6%] of 5596; HR 0·85 [95% CI 0·74–0·97], p=0·013). The same effect was not observed in patients without PCI (p=0·76, pinteraction=0·16). The proportion of patients with cardiovascular death was similar in both treatment groups (174 [3·1%] with ticagrelor vs 183 (3·3%) with placebo; HR 0·96 [95% CI 0·78–1·18], p=0·68), as well as all-cause death (282 [5·1%] vs 323 [5·8%]; 0·88 [0·75–1·03], p=0·11). TIMI major bleeding occurred in 111 (2·0%) of 5536 patients receiving ticagrelor and 62 (1·1%) of 5564 patients receiving placebo (HR 2·03 [95% CI 1·48–2·76], p<0·0001), and fatal bleeding in 6 (0·1%) of 5536 patients with ticagrelor and 6 (0·1%) of 5564 with placebo (1·13 [0·36–3·50], p=0·83). Intracranial haemorrhage occurred in 33 (0·6%) and 31 (0·6%) patients (1·21 [0·74–1·97], p=0·45). Ticagrelor improved net clinical benefit: 519/5558 (9·3%) versus 617/5596 (11·0%), HR=0·85, 95% CI 0·75–0·95, p=0·005, in contrast to patients without PCI where it did not, pinteraction=0·012. Benefit was present irrespective of time from most recent PCI. Interpretation: In patients with diabetes, stable coronary artery disease, and previous PCI, ticagrelor added to aspirin reduced cardiovascular death, myocardial infarction, and stroke, although with increased major bleeding. In that large, easily identified population, ticagrelor provided a favourable net clinical benefit (more than in patients without history of PCI). This effect shows that long-term therapy with ticagrelor in addition to aspirin should be considered in patients with diabetes and a history of PCI who have tolerated antiplatelet therapy, have high ischaemic risk, and low bleeding risk. Funding: AstraZeneca. © 2019 Elsevier Ltd

Filiaciones:
Bhatt D.L.:
 Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School BostonMA, United States

Steg P.G.:
 French Alliance for Cardiovascular Trials, Département Hospitalo-Universitaire FIRE, AP-HP, Hôpital Bichat, Université de Paris, Institut National de la Santé et de la Recherche Médicale U-1148, Paris, France

 National Heart and Lung Institute, Royal Brompton Hospital, Imperial College London, London, United Kingdom

Mehta S.R.:
 Population Health Research Institute, Hamilton Health Sciences, Hamilton, ON, Canada

 McMaster University, Hamilton, ON, Canada

Leiter L.A.:
 Li Ka Shing Knowledge Institute, St Michael's Hospital, University of Toronto, Toronto, ON, Canada

Simon T.:
 Department of Clinical Pharmacology-Clinical Research Platform (URCEST-CRB-CRCEST), AP-HP, Hôpital Saint Antoine, Sorbonne-Université, Paris, France

Fox K.:
 National Heart and Lung Institute, Royal Brompton Hospital, Imperial College London, London, United Kingdom

Held C.:
 Department of Medical Sciences, Cardiology, Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden

Andersson M.:
 AstraZeneca BioPharmaceuticals Research & Development, Late-stage Development, Cardiovascular, Renal and Metabolic, Mölndal, Sweden

Himmelmann A.:
 AstraZeneca BioPharmaceuticals Research & Development, Late-stage Development, Cardiovascular, Renal and Metabolic, Mölndal, Sweden

Ridderstråle W.:
 AstraZeneca BioPharmaceuticals Research & Development, Late-stage Development, Cardiovascular, Renal and Metabolic, Mölndal, Sweden

Chen J.:
 AstraZeneca BioPharmaceuticals Research & Development, Late-stage Development, Cardiovascular, Renal and Metabolic, Gaithersburg, MD, United States

Song Y.:
 Baim Institute for Clinical Research, Boston, MA, United States

Diaz R.:
 Department of Medicine, Estudios Clínicos Latino América, Rosario, Argentina

Goto S.:
 Department of Medicine (Cardiology), Tokai University School of Medicine, Isehara, Japan

James S.K.:
 Department of Medical Sciences, Cardiology and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden

Ray K.K.:
 Department of Primary Care and Public Health, Imperial Centre for Cardiovascular Disease Prevention, Imperial College London, London, United Kingdom

Parkhomenko A.N.:
 Institute of Cardiology, Emergency Cardiology Department, Kiev, Ukraine

Kosiborod M.N.:
 Saint Luke's Mid-America Heart Institute, University of Missouri–Kansas City, Kansas City, MO, United States

 The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia

McGuire D.K.:
 University of Texas Southwestern Medical Center, Dallas, TX, United States

Harrington R.A.:
 Department of Medicine, Stanford University, Stanford, CA, United States

Mehta S.:
 Population Health Research Institute, Hamilton Health Sciences, Hamilton, ON, Canada

 McMaster University, Hamilton, ON, Canada

Parkhomenko A.:
 Institute of Cardiology, Emergency Cardiology Department, Kiev, Ukraine
ISSN: 01406736
Editorial
Lancet Publishing Group, 360 PARK AVE SOUTH, NEW YORK, NY 10010-1710 USA, Estados Unidos America
Tipo de documento: Article
Volumen: 394 Número: 10204
Páginas: 1169-1180
ID de PubMed: 31484629
imagen All Open Access; Green

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