PEGASUS-TIMI 54

PEGASUS – TIMI 54 was a randomized, double-blind, placebo-controlled trial to assess the prevention of thrombotic events with ticagrelor on a background of aspirin therapy in patients with history of myocardial infarction.

MAIN RESULTS:
Long-term use of ticagrelor in patients with prior myocardial infarction

N Engl J Med. 2015 May 7;372(19):1791-800.

PRESENTATIONS

Main Results (Sabatine, ACC 2015)
PEGASUS Renal dysfunction (ESC 15)
PEGASUS-TIMI 54 PCI Subgroup 2015
PEGASUS-TIMI 54 P2Y12 Inhibitor Withdrawal 2015
PEGASUS-TIMI 54 Diabetes Subgroup (Bhatt, ACC 2016)
PEGASUS-TIMI 54 PAD Subgroup 2016PEGASUS Total events (AHA)
Caffeine (Furtado, AHA 2018)
No PCI (Furtado, AHA 2018)
hsTn (Marston, AHA 2018)
PEGASUS TMAO (Gencer, AHA 2019)
A Novel Genetic Risk Score Predicts Ischemic Stroke in Patients with Cardiometabolic Disease (Patel, AHA 2020)
Clinical Applications of a Polygenic Risk Score to Predict Atrial Fibrillation in Patients with Cardiometabolic Disease (Garfinkel, AHA 2021)
A Genetic Risk Score to Predict Peripheral Artery Disease and Acute Limb Ischemia in Patients With Cardiometabolic Disease (Patel, AHA 2021)
Lipoprotein(a), Cardiovascular Events, and Benefit of P2Y12 Inhibition-Insights from the PEGASUS-TIMI 54 Trial (Patel, ESC 2022)
Development of a Novel Polygenic Risk Score to Predict Risk of Aortic Stenosis Events (Small, AHA 2022)
Lipoprotein(a) and the risk of Major Adverse Limb Events in Patients with Stable Atherosclerotic Vascular Disease (Bonaca, ESC 2023)
Performance of a Polygenic Risk Score for CAD Across the Spectrum of ASCVD-An Analysis of 60k Patients from 6 TIMI Randomized Trials (Zimerman, AHA 2023)
Concurrent Evaluation Of HSTNI And HSTNT And Their Associations With Cardiovascular Events In 37,886 Patients With Stable Atherosclerotic Cardiovascular Disease (Bajaj, ACC 2024)
Pathogenic cardiomyopathy gene variants inform prognosis in atrial fibrillation-results from exome sequencing in over 17,000 patients in TIMI trials (Jurgens, ESC 2024)
Exome sequencing in over 63,000 patients in TIMI trials uncovers pathogenic cardiomyopathy variant carriers with high risk for heart failure and cardiovascular death (Kany, ESC 2024)
Polygenic Risk in Heart Failure (Haller, AHA 2024)
Polygenic Risk Score for Abdominal Aortic Aneurysm in Patients with Cardiometabolic Disease: Analysis of 40,000 Patients from 3 TIMI Trials (Lai, AHA 2025)

OTHER PUBLICATIONS

Design and rationale for the Prevention of Cardiovascular Events in Patients With Prior Heart Attack Using Ticagrelor Compared to Placebo on a Background of Aspirin-Thrombolysis in Myocardial Infarction 54 (PEGASUS-TIMI 54) trial. Am Heart J. 2014 Apr;167(4):437-444.e5.

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. Eur Heart J. 2016 Jan 21;37(4):400-8.

Ischaemic risk and efficacy of ticagrelor in relation to time from P2Y12 inhibitor withdrawal in patients with prior myocardial infarction: insights from PEGASUS-TIMI 54. Eur Heart J. 2016 Apr 7;37(14):1133-42.

Platelet Inhibition With Ticagrelor 60 mg Versus 90 mg Twice Daily in the PEGASUS-TIMI 54 Trial. J Am Coll Cardiol. 2016 Mar 15;67(10):1145-1154.

Reduction in Ischemic Events With Ticagrelor in Diabetic Patients With Prior Myocardial Infarction in PEGASUS-TIMI 54. J Am Coll Cardiol. 2016 Jun 14;67(23):2732-2740.

Ticagrelor for Prevention of Ischemic Events After Myocardial Infarction in Patients With Peripheral Artery Disease. J Am Coll Cardiol. 2016 Jun 14;67(23):2719-2728.

Long-term Tolerability of Ticagrelor for the Secondary Prevention of Major Adverse Cardiovascular Events: A Secondary Analysis of the PEGASUS-TIMI 54 Trial. JAMA Cardiol. 2016 Jul 1;1(4):425-32.

Prevention of Stroke with Ticagrelor in Patients with Prior Myocardial Infarction: Insights from PEGASUS-TIMI 54 (Prevention of Cardiovascular Events in Patients With Prior Heart Attack Using Ticagrelor Compared to Placebo on a Background of Aspirin-Thrombolysis in Myocardial Infarction 54). Circulation. 2016 Sep 20;134(12):861-71.

Antithrombotic Therapy in Patients With Peripheral Artery Disease. JAMA Cardiol. 2016 Oct 1;1(7):803-804.

Consistent platelet inhibition with ticagrelor 60 mg twice-daily following myocardial infarction regardless of diabetes status. Thromb Haemost. 2017 May 3;117(5):940-947.

Cost-Effectiveness of Long-Term Ticagrelor in Patients With Prior Myocardial Infarction: Results From the PEGASUS-TIMI 54 Trial. J Am Coll Cardiol. 2017 Aug 1;70(5):527-538.

Efficacy and Safety of Ticagrelor Over Time in Patients With Prior MI in PEGASUS-TIMI 54. J Am Coll Cardiol. 2017 Sep 12;70(11):1368-1375.

Ticagrelor for Secondary Prevention of Atherothrombotic Events in Patients With Multivessel Coronary Disease. J Am Coll Cardiol. 2018 Feb 6;71(5):489-496.

Reduction in Subtypes and Sizes of Myocardial Infarction With Ticagrelor in PEGASUS-TIMI 54. J Am Heart Assoc. 2018 Nov 20;7(22):e009260.

Pharmacokinetic-pharmacodynamic modelling of platelet response to ticagrelor in stable coronary artery disease and prior myocardial infarction patients. Br J Clin Pharmacol. 2019 Feb;85(2):413-421.

Efficacy and Safety with Ticagrelor in Patients with Prior Myocardial Infarction in the Approved European label: Insights from PEGASUS-TIMI 54. Eur Heart J Cardiovasc Pharmacother. 2019 Oct 1;5(4):200-206.

No Significant Relationship Between Ticagrelor and Sleep Apnea in Large, Randomized, Blinded Trials. JACC Cardiovasc Interv. 2020 Apr 27;13(8):1012-1014.

Gut Microbiota-Dependent Trimethylamine N-oxide and Cardiovascular Outcomes in Patients With Prior Myocardial Infarction: A Nested Case Control Study From the PEGASUS-TIMI 54 Trial. J Am Heart Assoc. 2020 May 18;9(10):e015331.

Clinical Application of High-Sensitivity Troponin Testing in the Atherosclerotic Cardiovascular Disease Framework of the Current Cholesterol Guidelines. JAMA Cardiol. 2020 Nov 1;5(11):1255-1262.

Clinical Application of a Novel Genetic Risk Score for Ischemic Stroke in Patients with Cardiometabolic Disease.Circulation. 2021;143:470–478.  

Genetic Risk Score to Identify Risk of Venous Thromboembolism in Patients with Cardiometabolic Disease. Circ Genom Precis Med. 2021 Feb;14(1):e003006.

Predictors, Type, and Impact of Bleeding on the Net Clinical Benefit of Long-Term Ticagrelor in Stable Patients With Prior Myocardial Infarction. 2021 Feb 9:e017008.

Sex, Permanent Drug Discontinuation, and Study Retention in Clinical Trials: Insights From the TIMI trials. Circulation. 2021 Feb 16;143(7):685-695.

Predictors, Type, and Impact of Bleeding on the Net Clinical Benefit of Long-Term Ticagrelor in Stable Patients With Prior Myocardial Infarction. J Am Heart Assoc. 2021 Feb 16;10(4):e017008.

Long-Term Ticagrelor in Patients With Prior Coronary Stenting in the PEGASUS-TIMI 54 Trial. J Am Heart Assoc. 2021 Sep 7;10(17):e020446.

A polygenic risk score predicts atrial fibrillation in cardiovascular disease. Eur Heart J. 2023 Jan 14;44(3):221-231.

Growth differentiation factor 15 and cardiovascular risk: individual patient meta-analysis.Eur Heart J. 2023 Jan 21;44(4):293-300.

Patient selection for long-term secondary prevention with ticagrelor: insights from PEGASUS-TIMI 54. Eur Heart J. 2022 Dec 21;43(48):5037-5044.

Influence of body weight and body mass index on the chronic pharmacokinetic and pharmacodynamic responses to clinically available doses of ticagrelor in patients with chronic coronary syndromes. Vascul Pharmacol. 2023 Apr;149:107145.

Lipoprotein(a) and Benefit of Antiplatelet Therapy: Insights from the PEGASUS-TIMI 54 Trial. JACC Adv. 2023 Nov;2(9):100675.

Novel Polygenic Risk Score and Established Clinical Risk Factors for Risk Estimation of Aortic Stenosis. JAMA Cardiol. 2024 Apr 1;9(4):357-366.

Clonal hematopoiesis, cardiovascular events and treatment benefit in 63,700 individuals from five TIMI randomized trials. Nat Med. 2024 Sep;30(9):2641-2647.

A Polygenic Risk Score to Predict Incident Heart Failure Across the Spectrum of Cardiovascular Risk. J Am Coll Cardiol. 2025 2025 Sep 23;86(12):860-873.

Pathogenic Cardiomyopathy-Associated Gene Variants and Prognosis in Atrial Fibrillation: Results in 18,000 Clinical Trial Participants. J Am Coll Cardiol. 2025 Sep 9;86(10):738-753.

Statistical approaches for systematically missing covariates in individual participant data meta-analysis: insights and applications using 5 large cardiovascular trials. Am J Epidemiol. 2025 Oct 9:kwaf226. doi: 10.1093/aje/kwaf226. 

Polygenic Risk Score for Coronary Artery Disease Across the Spectrum of Atherosclerotic Disease. Eur J Prev Cardiol. 2025 Oct 28:zwaf693. doi: 10.1093/eurjpc/zwaf693. 

A polygenic risk score for peripheral artery disease and major adverse limb events. Eur Heart J. 2025 Nov 28:ehaf891. doi: 10.1093/eurheartj/ehaf891.

Genomic and transcriptomic analyses of aortic stenosis enhance therapeutic target discovery and disease prediction. Nat Genet. 2025 Dec 19. doi: 10.1038/s41588-025-02417-6.