OBJECTIVES : We aimed to estimate potential benefits of prolonged dual-antiplatelet therapy (DAPT) in “real-world” patients after acute myocardial infarction (AMI) similar to those in PEGASUS-TIMI 54 (PT54) trial.

METHODS : We analyzed 6,258 consecutive patients who survived ≥1 year after AMI from 3 public hospitals between January 2005 and June 2018. Clinical characteristics, major adverse cardiovascular event (MACE, including MI, cardiovascular death and stroke) and TIMI major bleeding rates up to 3 years in patients who met PT54 trial inclusion/exclusion criteria (PEGASUS-like (PL) patients) were compared to those recruited in the PT54 trial to determine potential impact of trial results in patients after AMI. Subgroup analysis was performed in high ischemic and low bleeding risk patients.

RESULTS : 3,513 (56.1%) PL patients were older (mean age 72.2±11.3 vs. 65.4±8.3 years) with more women (30.7% vs. 24.3%) compared to placebo-patients in PT54 trial. 3-year MACE (9.4% vs. 9.0%) and major bleeding (1.1% vs. 1.1%) rates were comparable between PL and placebo-patients in the PT54 trial. Application of relative-risk reduction/increase from PT54 trial (ticagrelor 60mg daily group) to our PL patients estimated absolute risk reduction of 1.5% (95% CI 0.7-2.3) with number-needed-to-treat (NNT) of 66 (CI 43-138) to avoid one MACE; and absolute risk increase of 1.3% (CI 0.9-1.7) with number-needed-to-harm (NNH) of 78 (CI 60-106) to cause one major bleeding. In 1,373 (21.9%) patients with high ischemic and low bleeding risk, 3-year MACE (8.4%) and major bleeding (0.9%) rates were lower with more favorable estimated NNT of 63 (CI 42-115) and NNH of 111 (CI 82-172).

CONCLUSIONS : About 50% of patients a year or more after AMI are eligible for prolonged DAPT with ticagrelor. Estimated benefits of prolonged DAPT in “real-world” patients are similar to that observed in the PT54 trial and is likely to be greatest in patients with high ischemic and low bleeding risk.