{"id":"84f2c01af4cb","type":"article","url":"https://hartvaat.nl/2016/01/21/ticagrelor-bij-nierfunctiestoornissen-langetermijnpreventie-na-myocardinfarct-pe/","title":"Ticagrelor bij nierfunctiestoornissen: langetermijnpreventie na myocardinfarct (PEGASUS-TIMI 54)","title_en":"Efficacy and safety of ticagrelor for long-term secondary prevention of atherothrombotic events in relation to renal function: insights from the PEGASUS-TIMI 54 trial.","category":"preventie","category_label":"Preventie","professions":["cardioloog","internist"],"tags":["myocardinfarct","trombocytenaggregatieremmers"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehv482","source_url":"https://doi.org/10.1093/eurheartj/ehv482","authors":["Giulia Magnani","Robert F Storey","Gabriel Steg","Deepak L Bhatt","Marc Cohen","Julia Kuder","Kyungah Im","Philip Aylward","Diego Ardissino","Daniel Isaza","Alexander Parkhomenko","Assen R Goudev","Mikael Dellborg","Frederic Kontny","Ramon Corbalan","Felix Medina","Eva C Jensen","Peter Held","Eugene Braunwald","Marc S Sabatine","Marc P Bonaca"],"significance":6,"published":"2016-01-21","source_date":"2016-01-21","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/","https://hartvaat.nl/kennis/preventie/aspirine-primaire-preventie/"],"congress":"","summary_en":"This PEGASUS-TIMI 54 analysis examined the interaction between renal function and the efficacy of long-term ticagrelor therapy, showing consistent benefit across kidney function categories with an expected increase in bleeding at lower eGFR.","created":"2026-07-03T10:25:53Z","updated":"2026-07-03T13:25:15Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Analyse van PEGASUS-TIMI 54 naar de relatie tussen nierfunctie, ischemisch risico en bloedingsrisico, en de werkzaamheid van ticagrelor bij stabiele patiënten met een eerder myocardinfarct. Nierfunctie beïnvloedt het risicoprofiel significant.","abstract_original":"AIMS: We evaluated the relationship of renal function and ischaemic and bleeding risk as well as the efficacy and safety of ticagrelor in stable patients with prior myocardial infarction (MI). METHODS AND RESULTS: Patients with a history of MI 1-3 years prior from PEGASUS-TIMI 54 were stratified based on estimated glomerular filtration rate (eGFR), with <60 mL/min/1.73 m(2) pre-specified for analysis of the effect of ticagrelor on the primary efficacy composite of cardiovascular death, MI, or stroke (major adverse cardiovascular events, MACE) and the primary safety endpoint of TIMI major bleeding. Of 20 898 patients, those with eGFR <60 (N = 4849, 23.2%) had a greater risk of MACE at 3 years relative to those without, which remained significant after multivariable adjustment (hazard ratio, HRadj 1.54, 95% confidence interval, CI 1.27-1.85, P < 0.001). The relative risk reduction in MACE with ticagrelor was similar in those with eGFR <60 (ticagrelor pooled vs. placebo: HR 0.81; 95% CI 0.68-0.96) vs. ≥60 (HR 0.88; 95% CI 0.77-1.00, Pinteraction = 0.44). However, due to the greater absolute risk in the former group, the absolute risk reduction with ticagrelor was higher: 2.7 vs. 0.63%. Bleeding tended to occur more frequently in patients with renal dysfunction. The absolute increase in TIMI major bleeding with ticagrelor was similar in those with and without eGFR <60 (1.19 vs. 1.43%), whereas the excess of minor bleeding tended to be more pronounced (1.93 vs. 0.69%). CONCLUSION: In patients with a history of MI, patients with renal dysfunction are at increased risk of MACE and consequently experience a particularly robust absolute risk reduction with long-term treatment with ticagrelor."}