All studies on diabetics have shown these patients have higher risk rates of thrombotic events. This study sought to determine the optimal antiaggregation therapy with ticagrelor to prevent thrombotic events in diabetic patients with prior MI.

The study analyzed diabetic patient and non-diabetic patient subgroups (n=6806 and n=14355, respectively) from the PEGASUS–TIMI 54 trial (Prevention of Cardiovascular Events in Patients With Prior Heart Attack Using Ticagrelor Compared to Placebo on a Background of Aspirin–Thrombolysis In Myocardial Infarction 54), where 21,162 patients with a history of MI (between 1 and 3 years prior intervention) had been randomized to ticagrelor (90 mg or 60 mg twice a day) vs placebo.

Primary efficacy end point was major cardiovascular events (cardiovascular death, MI, or stroke) and primary safety end point was TIMI major bleeding (Thrombolysis in Myocardial Infarction).

Relative risk reduction of major events with ticagrelor was consistent, compared to placebo, in patients with diabetes (HR: 0.84; CI 95% 0.72 to 0.99; p=0.035) and also in those without diabetes (HR: 0.84; CI 95% 0.74 to 0.96; p = 0.013).

Since patients with diabetes present higher risk at baseline, absolute reduction of risk tends to be higher than in those without diabetes (1.5% vs. 1.1%, corresponding 3 year number needed to treat of 67 vs. 91).

In diabetic patients requiring pharmacological therapy to manage glycaemia (n=5960), absolute reduction was 1.9% with a 3 year number needed to treat of 53.

In patients with diabetes, ticagrelor reduces cardiovascular death in 22% and cardiac death 34%.

Similarly to patients without diabetes, patients with diabetes showed an increased rate of bleeding events (HR 2.56; CI 95% 1.52 to 4.33; p=0.0004).

Conclusion

In patients with diabetes and prior MI, adding ticagrelor to aspirin significantly reduces ischemic events risk, including cardiovascular death.

Original Title: Reduction in Ischemic Events with Ticagrelor in Diabetic Patients with Prior Myocardial Infarction in PEGASUS–TIMI 54.

Reference: Deepak L. Bhatt et al. J Am Coll Cardiol. 2016;67(23):2732-2740.

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