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Universal Classification System Type of Incident Myocardial Infarction in Patients With Stable Atherosclerosis: Observations From Thrombin Receptor Antagonist in Secondary Prevention of Atherothrombotic Ischemic Events (TRA 2 ° P) ‐ TIMI 50

View Article: PubMed Central - PubMed

ABSTRACT

Background: Our dual aims were as follows: (1) to classify new or recurrent myocardial infarctions (MI) in patients with stable atherosclerosis using the Universal Definition of MI classification system; and (2) to characterize the effects of vorapaxar, a first‐in‐class platelet protease‐activated receptor ‐1 antagonist, on new or recurrent MI.

Methods and results: We analyzed data from TRA 2°P‐TIMI 50, a multinational, randomized, double‐blind, placebo‐controlled trial of vorapaxar. This analysis included 20 770 patients with previous MI or peripheral arterial disease without a history of transient ischemic attack or stroke. Each new or recurrent MI after randomization that met the trial end point definition was further categorized according to the European Society of Cardiology, American College of Cardiology, American Heart Association, World Heart Federation Universal Definition classification of type and size. Of 1095 incident MIs, 77% were spontaneous (Type 1), with a smaller number (9.8%) of secondary MIs (Type 2). Vorapaxar reduced Type 1 MI (hazard ratio [HR] 0.84, CI 0.73–0.98, P=0.024), with a similar pattern for Type 2 MI (HR 0.74, CI 0.49–1.10, P=0.13). Notably, vorapaxar showed a consistent pattern of reduction across size of MIs, including MIs in the highest Universal MI size class (≥10× upper reference limit, HR 0.83, CI 0.70–0.98, P=0.025). As such, there was a significant reduction in larger, spontaneous MIs (Type 1, ≥10× upper reference limit, HR 0.81, CI 0.67–0.99, P=0.036), and a consistent pattern with respect to fatal MI (HR 0.66, CI 0.39–1.11, P=0.12).

Conclusions: Among stable patients with established atherosclerosis, the most common type of incident MI is spontaneous MI, and the reduction in MI with vorapaxar was consistent across MIs of varying type and size, including spontaneous infarctions ≥10× upper reference limit.

Clinical trial registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT00526474.

No MeSH data available.


Related in: MedlinePlus

Flow diagram of myocardial infarctions included in the analysis. MI indicates myocardial infarction; PAD, peripheral arterial disease; TIA, transient ischemic attack.
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jah31631-fig-0001: Flow diagram of myocardial infarctions included in the analysis. MI indicates myocardial infarction; PAD, peripheral arterial disease; TIA, transient ischemic attack.

Mentions: Among the 20 770 patients included in this analysis, 1095 incident MIs of known type and size occurred during a median follow‐up of 30 months (Figure 1). There was 1 Type 3 and 1 Type 5 MI, which, given their rarity, are not characterized in further detail in this report. The majority of incident MIs (n=918, 84%) were in patients who qualified for the trial with a history of MI. Among patients with an incident MI after randomization, 132 patients had multiple MIs, accounting for an additional 203 of the 1095 MIs.


Universal Classification System Type of Incident Myocardial Infarction in Patients With Stable Atherosclerosis: Observations From Thrombin Receptor Antagonist in Secondary Prevention of Atherothrombotic Ischemic Events (TRA 2 ° P) ‐ TIMI 50
Flow diagram of myocardial infarctions included in the analysis. MI indicates myocardial infarction; PAD, peripheral arterial disease; TIA, transient ischemic attack.
© Copyright Policy - creativeCommonsBy-nc-nd
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5015369&req=5

jah31631-fig-0001: Flow diagram of myocardial infarctions included in the analysis. MI indicates myocardial infarction; PAD, peripheral arterial disease; TIA, transient ischemic attack.
Mentions: Among the 20 770 patients included in this analysis, 1095 incident MIs of known type and size occurred during a median follow‐up of 30 months (Figure 1). There was 1 Type 3 and 1 Type 5 MI, which, given their rarity, are not characterized in further detail in this report. The majority of incident MIs (n=918, 84%) were in patients who qualified for the trial with a history of MI. Among patients with an incident MI after randomization, 132 patients had multiple MIs, accounting for an additional 203 of the 1095 MIs.

View Article: PubMed Central - PubMed

ABSTRACT

Background: Our dual aims were as follows: (1) to classify new or recurrent myocardial infarctions (MI) in patients with stable atherosclerosis using the Universal Definition of MI classification system; and (2) to characterize the effects of vorapaxar, a first‐in‐class platelet protease‐activated receptor ‐1 antagonist, on new or recurrent MI.

Methods and results: We analyzed data from TRA 2°P‐TIMI 50, a multinational, randomized, double‐blind, placebo‐controlled trial of vorapaxar. This analysis included 20 770 patients with previous MI or peripheral arterial disease without a history of transient ischemic attack or stroke. Each new or recurrent MI after randomization that met the trial end point definition was further categorized according to the European Society of Cardiology, American College of Cardiology, American Heart Association, World Heart Federation Universal Definition classification of type and size. Of 1095 incident MIs, 77% were spontaneous (Type 1), with a smaller number (9.8%) of secondary MIs (Type 2). Vorapaxar reduced Type 1 MI (hazard ratio [HR] 0.84, CI 0.73–0.98, P=0.024), with a similar pattern for Type 2 MI (HR 0.74, CI 0.49–1.10, P=0.13). Notably, vorapaxar showed a consistent pattern of reduction across size of MIs, including MIs in the highest Universal MI size class (≥10× upper reference limit, HR 0.83, CI 0.70–0.98, P=0.025). As such, there was a significant reduction in larger, spontaneous MIs (Type 1, ≥10× upper reference limit, HR 0.81, CI 0.67–0.99, P=0.036), and a consistent pattern with respect to fatal MI (HR 0.66, CI 0.39–1.11, P=0.12).

Conclusions: Among stable patients with established atherosclerosis, the most common type of incident MI is spontaneous MI, and the reduction in MI with vorapaxar was consistent across MIs of varying type and size, including spontaneous infarctions ≥10× upper reference limit.

Clinical trial registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT00526474.

No MeSH data available.


Related in: MedlinePlus