June 4, 2026European Heart Journal5 citationsOpen Access
View Full PaperP3670Efficacy and safety with ticagrelor in patients with prior myocardial infarction in the approved European label: insights from PEGASUS-TIMI 54
Key Result
An initial hsTnT value <5ng/L yielded a 100% negative predictive value for ACS, revascularization, or death at 1-month follow-up in patients undergoing early stress testing.
Key Points
- To assess the efficacy and safety of ticagrelor in patients with a history of myocardial infarction.
- Included 274 patients with an interpretable EKG and negative hsTnT values for acute coronary syndrome.
- Conducted early treadmill stress tests, evaluated by independent cardiologists for diagnostic precision.
- Followed up for intra-hospital events and additional diagnostics like SPECT or coronary angiogram in positive stress tests.
- 74 patients (27%) had initial hsTnT values <5ng/L, with a median age of 49 years.
- All 9 positive stress tests were followed by additional diagnostics that turned out negative, achieving 100% specificity.
- No acute coronary syndrome, revascularization, or deaths were recorded in the 1-month follow-up, indicating a negative predictive value of 100% for the hsTnT cut-off.
Study Design
Type
Observational (n=274)
Structured PICO
Does an initial hsTnT <5ng/L safely rule out acute coronary syndrome in patients with an interpretable EKG undergoing early treadmill stress testing?
P
Population
274 patients with suspected acute coronary syndrome, an interpretable EKG, and negative hsTnT undergoing early treadmill stress testing, followed for 1 month.
E
Exposure
Initial hsTnT <5ng/L
O
Outcome
Definite ACS diagnosis by independent cardiologists and presentation of intra-hospital events and in the 1-month follow-up (ACS, revascularization, or death)hard clinical
An initial hsTnT <5ng/L in patients with an interpretable EKG safely rules out ACS with a 100% negative predictive value at 1 month.
Main Result
Effect estimate: NPV 100%
Abstract
the 2013-2015 period. Patients with an interpretable EKG and a negative value of hsTnT for acute coronary syndrome (ACS) were included, all of them undergoing an early non-pharmacological treadmill stress test. Diagnostic precision was evaluated using a definite ACS diagnosis by independent cardiologists. Security was evaluated by presentation of intra-hospital events and in the follow-up. Results: Of a total of 274 patients, 74 (27%) had an initial hsTnT value of <5ng/L. This group had a median age of 49 years, 44% of them being men with a low percentage of diabetics, and only 5% of them with previous history of ischemic cardiomyopathy. A total of 65 (87%) negative and 9 (13%) positive stress tests were registered. In all positive cases a second diagnostic test was performed: 5 by a nuclear stress testing (SPECT) and 4 by a coronary angiogram, all of them turning out negative or without coronary lesions. There was no final diagnosis for ACS, allowing calculating a 100% specificity value. No ACS, revascularization or death were registered in a 1-month followup in this group of patients, thus estimating a negative predictive value (NPV) of 100% for this cut point.
Expert Takes5 quotes
1/5
“The conclusion for both clinicians and patients at high-risk of CV death post-MI is clear: Treatment with Brilinta 60mg, either as continuation therapy after the initial 12 month post-event period, or with as limited interruption as possible, is associated with a clear and favourable benefit-risk ratio for this population of patients. This new insight is potentially practice-changing, as while more than seven million people worldwide suffer a heart attack each year, we know that fewer than half receive adequate long-term treatment to reduce their risk of further CV events.”
Mikael Dellborg, Professor of Cardiology, University of GothenburgUniversity of Gothenburgauto_pipelineView source