BACKGROUND Guidelines recommend extended dual antiplatelet therapy (DAPT), including ticagrelor 60 mg twice daily, in high-risk post myocardial infarction (MI) patients who have tolerated 12 months and are not at high bleeding risk. The real-world utilization and bleeding and ischemic outcomes associated with long-term ticagrelor 60 mg in routine clinical practice have not been well described. METHODS Register and claims data from US (Optum Clinformatics, IBM MarketScan, Medicare) and Europe (Sweden, Italy, UK, Germany) were extracted. Patients initiating ticagrelor 60 mg ≥ 12 months after MI, meeting eligibility criteria for PEGASUS-TIMI 54 trial, were included. The cumulative incidence of the composite of MI, stroke, or all-cause mortality, and of bleeding requiring hospitalization were calculated. Meta-analyses were performed to combine estimates from each source. RESULTS 7 035 patients treated with ticagrelor 60 mg met eligibility criteria. Median age was 67 years and 29% were females; 12% had a history of multiple MIs. The majority (95%) had been treated with ticagrelor 90 mg prior to initiating ticagrelor 60 mg. At 12 months from initiation of ticagrelor 60 mg, the cumulative incidence (95% CI) of MI, stroke or mortality was 3.33% (2.73-4.04) and was approximately three-fold the risk of bleeding (0.96%; 0.69-1.33). CONCLUSIONS This study provides insights into the use of ticagrelor 60 mg in patients with prior MI in clinical practice. Observed event rates for ischemic events and bleeding generally align with those in the pivotal trials, support the established safety profile of ticagrelor, and highlight the significant residual ischemic risk in this population.Clinical Trials.gov Registration NCT04568083.

中文翻译：

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接受替格瑞洛 60 mg 双重抗血小板延长治疗的既往心肌梗死患者的特征和结果：来自多国观察性研究 ALTEHEIA 的结果。

背景指南建议对已耐受 12 个月且出血风险不高的高危心肌梗死 (MI) 后患者进行延长双联抗血小板治疗 (DAPT)，包括替格瑞洛 60 mg，每日两次。在常规临床实践中，与长期替格瑞洛 60 mg 相关的实际应用以及出血和缺血结局尚未得到很好的描述。方法 提取来自美国（Optum Clinformatics、IBM MarketScan、Medicare）和欧洲（瑞典、意大利、英国、德国）的登记和索赔数据。纳入了 MI 后 12 个月以上开始服用替格瑞洛 60 mg、符合 PEGASUS-TIMI 54 试验资格标准的患者。计算了心肌梗死、中风或全因死亡率以及需要住院的出血的复合累积发生率。进行荟萃分析以结合每个来源的估计。结果 7 035 名接受替格瑞洛 60 mg 治疗的患者符合资格标准。中位年龄为 67 岁，其中 29% 为女性；12% 有多次心肌梗死病史。大多数人 (95%) 在开始服用替格瑞洛 60 mg 之前已接受过替格瑞洛 90 mg 治疗。开始服用替格瑞洛 60 mg 后 12 个月时，心肌梗死、卒中或死亡的累积发生率 (95% CI) 为 3.33% (2.73-4.04)，大约是出血风险的三倍 (0.96%；0.69-1.33) 。结论 本研究提供了在临床实践中对既往有 MI 的患者使用替格瑞洛 60 mg 的见解。观察到的缺血事件和出血事件发生率通常与关键试验中的事件发生率一致，支持替格瑞洛既定的安全性，并强调了该人群中显着的残余缺血风险。Clinical Trials.gov 注册号 NCT04568083。