Evidence map›Paper›PMID 25773268›Full record

Trial reportThe New England journal of medicine2015

Long-term use of ticagrelor in patients with prior myocardial infarction.

Marc P Bonaca, Deepak L Bhatt, Marc Cohen, Philippe Gabriel Steg, Robert F Storey, Eva C Jensen, Giulia Magnani, Sameer Bansilal, M Polly Fish, Kyungah Im and 16 more

5 registry-linked trialsAbstract readMulticenter StudyRandomized Controlled Trial
PubMed Publisher
In one paragraph

Trial report in The New England journal of medicine, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 5 registered trials, which are not on this map. Cited by 611 papers, 19 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
611citing papers in PubMed, 19 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT01225562 phase3completednot on this map

A Randomized, Double-Blind, Placebo Controlled, Parallel Group, Multinational Trial, to Assess the Prevention of Thrombotic Events With Ticagrelor Compared to Placebo on a Background of Acetyl Salicylic Acid (ASA) Therapy in Patients With History of Myocardial Infarction

TypeinterventionalSponsorAstraZenecaRan2010 to 2014Enrolled21,379ConditionsMyocardial Infarction, Cardiovascular Death, Atherothrombosis, StrokeArmsTicagrelor 90 mg, Ticagrelor 60 mg, Ticagrelor Placebo
NCT03378934 phase4recruitingnot on this mapstarted 2018, after this paper: background citation

A Single-center, Randomized, Open-label, Controlled, Dose-escalating, Parallel-group Study to Assess the Anti-platelet Effect of Berberine in Patients Receiving Aspirin and Clopidogrel After Percutaneous Coronary Intervention

TypeinterventionalSponsorPeking Union Medical College HospitalRan2018 to 2026Enrolled64ConditionsCoronary Artery Disease, Percutaneous Coronary InterventionArmsBerberine, Standard treatment, Aspirin, Clopidogrel
NCT03729401 phase4terminatednot on this mapstarted 2019, after this paper: background citation

Personalization of Long-Term Antiplatelet Therapy Using a Novel Combined Demographic/Pharmacogenomic Strategy - The RAPID EXTEND Randomized Study

TypeinterventionalSponsorOttawa Heart Institute Research CorporationRan2019 to 2026Enrolled39ConditionsCoronary Artery Disease, Myocardial InfarctionArmsActive Comparator: Dual Antiplatelet Therapy (DAPT) - Aspirin 81 mg + Ticagrelor 60mg twice daily, Ticagrelor Monotherapy: Ticagrelor 60 mg twice daily, Personalized Therapy Arm: Aspirin 81 mg or Ticagrelor 60mg twice daily or Clopidogrel 75 mg once daily
NCT03881943 phase4completednot on this mapstarted 2017, after this paper: background citation

A Randomized, Single Center Trial to Assess the Endothelial Function With Ticagrelor Monotherapy Compared to Aspirin Monotherapy in Patients With History of Acute Coronary Syndrome

TypeinterventionalSponsorThe University of Hong KongRan2017 to 2018Enrolled200ConditionsAcute Coronary SyndromeArmsTicagrelor 60 mg, Aspirin 100 MG Oral Tablet, Enteric Coated
NCT04739384 phase3completednot on this mapstarted 2021, after this paper: background citation

Platelet Inhibition With Ticagrelor 60 mg Versus Ticagrelor 90 mg Twice Daily in Elderly Patients With Acute Coronary Syndrome (ACS)

TypeinterventionalSponsorFederico II UniversityRan2021 to 2022Enrolled50ConditionsAcute Coronary Syndrome, STEMI, NSTEMI, Coronary Artery DiseaseArmsTicagrelor 90mg, Ticagrelor 60 mg
3 · Its place in the literature

Who cites it

611 citing papers in PubMed, 19 syntheses or guidelines pooled it.

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  2. [Efficacy and safety of dual anti-platelet aggregation short post-pharmacologic stent].Revista medica del Instituto Mexicano del Seguro Social · 2026
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  8. P2YBMJ (Clinical research ed.) · 2025
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551 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

26 authors.

Marc P BonacaFrom the Thrombolysis in Myocardial Infarction (TIMI) Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston (M.P.B., D.L.B., G.M., M.P.F., K.I., S.A.M., S.D.W., E.B., M.S.S.); the Cardiovascular Division, Department of Medicine, Newark Beth Israel Medical Center, Rutgers-New Jersey Medical School, Newark (M.C.); French Alliance for Cardiovascular Trials, Département Hospitalo-Universitaire Fibrosis, Inflammation, Remodeling, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, INSERM Unité 1148, and Université Paris-Diderot, Sorbonne Paris Cité - all in Paris (P.G.S.); National Heart and Lung Institute, Royal Brompton Hospital, Imperial College, London (P.G.S.), and Department of Cardiovascular Science, University of Sheffield, Sheffield, United Kingdom (R.F.S.); AstraZeneca, Mölndal, Sweden (E.C.J., O.B., P.H.); Icahn School of Medicine at Mount Sinai, New York (S.B.); Canisius-Wilhelmina Hospital, Nijmegen, the Netherlands (T.O.O.); Postgraduate Medical School, Grochowski Hospital, Warsaw, Poland (A.B.); Montreal Heart Institute, Université de Montréal, Montreal (P.T.); Cardiology Research Center, Moscow (M.R.); Kerckhoff Heart Center, Bad Nauheim, and University of Giessen, Giessen - both in Germany (C.H.); Department of Medicine (Cardiology), Tokai University School of Medicine, Isehara, Japan (S.G.); University Hospital, Jihlavska, Brno, Czech Republic (J.S.); Heart Institute (InCor)-University of São Paulo Medical School, São Paulo (J.C.N.); and the Department of Cardiology, Military Hospital, Budapest, Hungary (R.G.K.).
Deepak L Bhatt
Marc Cohen
Philippe Gabriel Steg
Robert F Storey
Eva C Jensen
Giulia Magnani
Sameer Bansilal
M Polly Fish
Kyungah Im
Olof Bengtsson
Ton Oude Ophuis
Andrzej Budaj
Pierre Theroux
Mikhail Ruda
Christian Hamm
Shinya Goto
Jindrich Spinar
José Carlos Nicolau
Robert G Kiss
Sabina A Murphy
Stephen D Wiviott
Peter Held
Eugene Braunwald
Marc S Sabatine
PEGASUS-TIMI 54 Steering Committee and Investigators

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThe potential benefit of dual antiplatelet therapy beyond 1 year after a myocardial infarction has not been established. We investigated the efficacy and safety of ticagrelor, a P2Y12 receptor antagonist with established efficacy after an acute coronary syndrome, in this context.

methodsWe randomly assigned, in a double-blind 1:1:1 fashion, 21,162 patients who had had a myocardial infarction 1 to 3 years earlier to ticagrelor at a dose of 90 mg twice daily, ticagrelor at a dose of 60 mg twice daily, or placebo. All the patients were to receive low-dose aspirin and were followed for a median of 33 months. The primary efficacy end point was the composite of cardiovascular death, myocardial infarction, or stroke. The primary safety end point was Thrombolysis in Myocardial Infarction (TIMI) major bleeding.

resultsThe two ticagrelor doses each reduced, as compared with placebo, the rate of the primary efficacy end point, with Kaplan-Meier rates at 3 years of 7.85% in the group that received 90 mg of ticagrelor twice daily, 7.77% in the group that received 60 mg of ticagrelor twice daily, and 9.04% in the placebo group (hazard ratio for 90 mg of ticagrelor vs. placebo, 0.85; 95% confidence interval [CI], 0.75 to 0.96; P=0.008; hazard ratio for 60 mg of ticagrelor vs. placebo, 0.84; 95% CI, 0.74 to 0.95; P=0.004). Rates of TIMI major bleeding were higher with ticagrelor (2.60% with 90 mg and 2.30% with 60 mg) than with placebo (1.06%) (P<0.001 for each dose vs. placebo); the rates of intracranial hemorrhage or fatal bleeding in the three groups were 0.63%, 0.71%, and 0.60%, respectively.

conclusionsIn patients with a myocardial infarction more than 1 year previously, treatment with ticagrelor significantly reduced the risk of cardiovascular death, myocardial infarction, or stroke and increased the risk of major bleeding. (Funded by AstraZeneca; PEGASUS-TIMI 54 ClinicalTrials.gov number, NCT01225562.).

Indexed as

AdenosineAgedAspirinCardiovascular DiseasesDouble-Blind MethodDrug Administration ScheduleDrug Therapy, CombinationFemaleHemorrhageHumansIntracranial HemorrhagesKaplan-Meier EstimateMaleMiddle AgedMyocardial InfarctionPlatelet Aggregation InhibitorsAdenosineAspirinPlatelet Aggregation InhibitorsPurinergic P2Y Receptor AntagonistsTicagrelor

Identifiers

PMID25773268

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.