Ticagrelor for the prevention of ischemic events in patients with prior myocardial infarction and peripheral artery disease

ABSTRACT

Introduction: Cardiovascular disease (CVD) is the main cause of death in the world. Coronary artery disease (CAD) is the most common form of CVD presentation, but the prevalence of peripheral artery disease (PAD) is increasing. Patients with polyvascular disease comprise a very high-risk population that has been infrequently studied.

Areas covered: The authors review the current evidence of the efficacy and safety of ticagrelor in the setting of acute coronary syndrome and stable patients post-MI with and without PAD and summarize its pharmacokinetics, pharmacodynamics, and regulatory issues.

Expert opinion: Randomized studies showed that ticagrelor is superior to clopidogrel in patients with acute coronary syndromes, and is superior to placebo in the chronic phase (>1 year) post-myocardial infarction. Sub-analyses of these studies suggest that patients with myocardial infarction and PAD, compared to patients without these characteristics, may have greater benefit with ticagrelor. Nonetheless, the global evidence about the role of ticagrelor in patients with myocardial infarction and PAD remains relatively sparse, and a prospective randomized trial testing this hypothesis would be necessary to provide more definite data regarding the efficacy and safety of ticagrelor in this very high-risk population.

KEYWORDS:

• Antiplatelet therapy
• myocardial infarction
• peripheral artery disease
• ticagrelor

Acknowledgments

The authors are indebted to Deborah Gurski for her editorial support.

Declaration of interest

JC Nicolau reports in the last 12 months that he received grants and personal fees (either as a member of an advisory board or from lectures) from AstraZeneca, Daiichi Sankyo, Sanofi and Merck & Co. LM Baracioli reports that in the last 12 months he received grants from AstraZeneca, Daiichi Sankyo, Sanofi and Merck and Co, and lecture fees from AstraZeneca and Daiichi Sankyo. RP Giugliano declares that in the past 12 months, he has received clinical trial/research support from Amgen Inc while also receiving honoraria for CME lectures from Amgen, Daiichi Sankyo and Merck & Co. He has also acted as a consultant for Amarin, Amgen Inc, Boehringer Ingelheim, Bristol-Myers Squibb, CVS Caremark, Daiichi Sankyo, GlaxoSmithKline, Lexicon, Merck & Co., Portola and Pfizer Inc. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose

Additional information

Funding

This manuscript has not been funded.