Does long-term ticagrelor treatment improve outcomes in patients with previous percutaneous coronary intervention?

This study looked at long-term treatment with ticagrelor (Brilique) after percutaneous coronary intervention (PCI) in patients with coronary artery disease (CAD). It found that compared to patients treated with placebo, those treated with ticagrelor were less likely to have a major cardiovascular event (MACE). 

Coronary artery disease (CAD) is a condition in which the blood vessels in the heart become blocked. This can lead to MACE (heart attack, stroke, or death due to heart disease). Percutaneous coronary intervention (PCI) is a procedure used to treat CAD. PCI involved unblocking the affected arteries and using a stent to keep them open.  

Blood clots can form on stents causing a blockage. Long-term blood-thinning medications such as antiplatelet agents are used to reduce the risk of clots forming. Acetylsalicylic acid (aspirin) and ticagrelor are antiplatelet medications. Aspirin is commonly used after a PCI. However, it is unclear whether long-term add-on ticagrelor improves outcomes in patients after PCI.

16,891 patients were involved in this study. All had undergone PCI for the treatment of CAD in the past 3 years. Patients were divided into 3 groups. Group 1 received ticagrelor 90 mg twice daily. Group 2 received ticagrelor 60 mg twice daily. Group 3 received a placebo. All groups also received low-dose aspirin daily. Patients were followed for an average of 33 months.

Patients treated with ticagrelor were 15% less likely to have a MACE compared to patients treated with placebo. This was true for all types of stents. Patients treated with ticagrelor were 27% less likely to develop blood clots blocking the stent than patients treated with placebo. However, patients treated with ticagrelor were 2.65 times more likely to have a major bleeding compared to patients treated with placebo.  

This study showed that long-term ticagrelor treatment reduced the risk of heart attack, stroke or death, with a higher risk of bleeding, in patients with CAD who have had PCI treatment. 

Some background information on the types of stents used was not available for this study. Further studies are needed to confirm these results. This study was funded by AstraZeneca, the manufacturer of ticagrelor.