Is ticagrelor effective in people with multi-vessel coronary artery disease?

This study examined the safety and effectiveness of ticagrelor (Brilinta) in patients with multi-vessel coronary disease (MVD) who had a previous heart attack. It was determined that ticagrelor reduced the risk of major adverse cardiac events (MACE), but increased the risk of certain types of bleeding.

Coronary artery disease is a condition caused by narrowing or blocking of blood vessels that supply the heart. This reduces the supply of blood to the heart. In MVD, more than one blood vessel is blocked or narrowed.

Platelets are a type of blood-cell that can block blood vessels by forming clots. Ticagrelor is a drug that stops platelets from forming clots.

People with MVD who have already had a heart attack are at higher risk of having a MACE or coronary event. A MACE is death from cardiovascular causes, heart attack, or a stroke. A coronary event is death from coronary artery disease, heart attack, or a blood clot forming in a stent (flexible tube that is put into a blood vessel to keep it open). Research about medications in people with MVD who have already had a heart attack is limited.

12,558 adults with MVD who had had a heart attack in the last 1-3 years were recruited. They were randomly divided into 3 groups. Two groups received different doses of ticagrelor. The other group received a placebo (drug with no active effect). Both groups also received low doses of aspirin (another drug that stops platelets from forming clots). None of the groups knew which medication they were receiving. They were followed up for an average of 33 months.

The groups that received ticagrelor were 18% less likely to experience a MACE than the placebo group. They were 24% less likely to have a coronary event. They were 36% less likely to die from coronary artery disease, and 21% less likely to have another heart attack.

The groups that receive ticagrelor were 2.67 times more likely to experience major bleeding than the placebo group. However, the risk of bleeding in the brain, and bleeding resulting in death, was not increased by ticagrelor. 

The study concluded that ticagrelor reduces the risk of MACE and coronary events, but increases the risk of some types of major bleeding.

This study was funded by AstraZeneca, the manufacturers of ticagrelor. 

Discuss the safety and effectiveness of ticagrelor with your physician.