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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

Kaplan–Meier estimated rates of MIs that were spontaneous (A) or in the highest Universal classification system size class (≥10× URL) (B) with vorapaxar vs placebo. MI indicates myocardial infarction; URL, upper reference limit.
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jah31631-fig-0006: Kaplan–Meier estimated rates of MIs that were spontaneous (A) or in the highest Universal classification system size class (≥10× URL) (B) with vorapaxar vs placebo. MI indicates myocardial infarction; URL, upper reference limit.

Mentions: Compared with placebo, vorapaxar significantly reduced the incidence of overall MI with a consistent pattern of reduction across MI of each type (Figure 5). Specifically, vorapaxar reduced spontaneous MI (Type 1, HR 0.84, CI 0.73–0.98, P=0.024; Figure 6A), with a similar pattern for secondary MI (Type 2, HR 0.74, CI 0.49–1.10, P=0.13). The reduction in incident MI with vorapaxar was also consistent across ST‐segment elevation MIs (HR 0.81, CI 0.61–1.07) and non‐ST‐segment elevation MIs (HR 0.83, CI 0.72–0.96).


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
Kaplan–Meier estimated rates of MIs that were spontaneous (A) or in the highest Universal classification system size class (≥10× URL) (B) with vorapaxar vs placebo. MI indicates myocardial infarction; URL, upper reference limit.
© Copyright Policy - creativeCommonsBy-nc-nd
Related In: Results  -  Collection

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

jah31631-fig-0006: Kaplan–Meier estimated rates of MIs that were spontaneous (A) or in the highest Universal classification system size class (≥10× URL) (B) with vorapaxar vs placebo. MI indicates myocardial infarction; URL, upper reference limit.
Mentions: Compared with placebo, vorapaxar significantly reduced the incidence of overall MI with a consistent pattern of reduction across MI of each type (Figure 5). Specifically, vorapaxar reduced spontaneous MI (Type 1, HR 0.84, CI 0.73–0.98, P=0.024; Figure 6A), with a similar pattern for secondary MI (Type 2, HR 0.74, CI 0.49–1.10, P=0.13). The reduction in incident MI with vorapaxar was also consistent across ST‐segment elevation MIs (HR 0.81, CI 0.61–1.07) and non‐ST‐segment elevation MIs (HR 0.83, CI 0.72–0.96).

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