{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T22:17:41Z","timestamp":1791497861889,"version":"4.3.4"},"reference-count":15,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circulation"],"published-print":{"date-parts":[[2016,7,26]]},"abstract":"<jats:sec>\n            <jats:title>Background:<\/jats:title>\n            <jats:p>Patients with stable ischemic heart disease and previous myocardial infarction (MI) vary in their risk for recurrent cardiovascular events. Atherothrombotic risk assessment may be useful to identify high-risk patients who have the greatest potential to benefit from more intensive secondary preventive therapy such as treatment with vorapaxar.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods:<\/jats:title>\n            <jats:p>We identified independent clinical indicators of atherothrombotic risk among 8598 stable, placebo-treated patients with a previous MI followed up for 2.5 years (median) in TRA 2\u00b0P-TIMI 50 [Thrombin Receptor Antagonist in Secondary Prevention of Atherothrombotic Ischemic Events\u2013TIMI 50]. The efficacy and safety of vorapaxar (SCH 530348; MK-5348) were assessed by baseline risk among patients with previous MI without prior stroke or transient ischemic attack for whom there is a clinical indication for vorapaxar. End points were cardiovascular death, MI, or ischemic stroke and GUSTO (Global Use of Strategies to Open Occluded Coronary Arteries) severe bleeding.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results:<\/jats:title>\n            <jats:p>\n              The 9 independent risk predictors were age, diabetes mellitus, hypertension, smoking, peripheral arterial disease, previous stroke, previous coronary bypass grafting, heart failure, and renal dysfunction. A simple integer-based scheme using these predictors showed a strong graded relationship with the rate of cardiovascular death\/MI\/ischemic stroke and the individual components (\n              <jats:italic>P<\/jats:italic>\n              for trend &lt;0.001 for all). High-risk patients (\u22653 risk indicators; 20% of population) had a 3.2% absolute risk reduction in cardiovascular disease\/MI\/ischemic stroke with vorapaxar, and intermediate-risk patients (1\u20132 risk indicators; 61%) had a 2.1% absolute risk reduction (\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001 each), translating to a number needed to treat of 31 and 48. Bleeding increased across risk groups (\n              <jats:italic>P<\/jats:italic>\n              for trend&lt;0.01); however, net clinical outcome was increasingly favorable with vorapaxar across risk groups. Fatal bleeding or intracranial hemorrhage was 0.9% with both treatments in high-risk patients.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions:<\/jats:title>\n            <jats:p>Stratification of baseline atherothrombotic risk can assist with therapeutic decision making for vorapaxar use for secondary prevention after MI.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Clinical Trial Registration:<\/jats:title>\n            <jats:p>\n              URL:\n              <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.clinicaltrials.gov\">https:\/\/www.clinicaltrials.gov<\/jats:ext-link>\n              . Unique identifier: NCT00526474.\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circulationaha.115.019861","type":"journal-article","created":{"date-parts":[[2016,7,21]],"date-time":"2016-07-21T03:39:07Z","timestamp":1469072347000},"page":"304-313","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":155,"title":["Atherothrombotic Risk Stratification and the Efficacy and Safety of Vorapaxar in Patients With Stable Ischemic Heart Disease and Previous Myocardial Infarction"],"prefix":"10.1161","volume":"134","author":[{"given":"Erin A.","family":"Bohula","sequence":"first","affiliation":[{"name":"From the TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women\u2019s Hospital, Harvard Medical School, Boston, MA (E.A.B., M.P.B., E.B., P.H., S.A.M., M.S.S., B.M.S., D.A.M.); South Australian Health and Research Institute, Flinders University and Medical Centre, Adelaide (P.E.A.); Division of Cardiovascular Diseases, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago (R.C.); Department of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia,..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc P.","family":"Bonaca","sequence":"additional","affiliation":[{"name":"From the TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women\u2019s Hospital, Harvard Medical School, Boston, MA (E.A.B., M.P.B., E.B., P.H., S.A.M., M.S.S., B.M.S., D.A.M.); South Australian Health and Research Institute, Flinders University and Medical Centre, Adelaide (P.E.A.); Division of Cardiovascular Diseases, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago (R.C.); Department of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia,..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eugene","family":"Braunwald","sequence":"additional","affiliation":[{"name":"From the TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women\u2019s Hospital, Harvard Medical School, Boston, MA (E.A.B., M.P.B., E.B., P.H., S.A.M., M.S.S., B.M.S., D.A.M.); South Australian Health and Research Institute, Flinders University and Medical Centre, Adelaide (P.E.A.); Division of Cardiovascular Diseases, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago (R.C.); Department of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia,..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philip E.","family":"Aylward","sequence":"additional","affiliation":[{"name":"From the TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women\u2019s Hospital, Harvard Medical School, Boston, MA (E.A.B., M.P.B., E.B., P.H., S.A.M., M.S.S., B.M.S., D.A.M.); South Australian Health and Research Institute, Flinders University and Medical Centre, Adelaide (P.E.A.); Division of Cardiovascular Diseases, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago (R.C.); Department of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia,..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ramon","family":"Corbalan","sequence":"additional","affiliation":[{"name":"From the TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women\u2019s Hospital, Harvard Medical School, Boston, MA (E.A.B., M.P.B., E.B., P.H., S.A.M., M.S.S., B.M.S., D.A.M.); South Australian Health and Research Institute, Flinders University and Medical Centre, Adelaide (P.E.A.); Division of Cardiovascular Diseases, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago (R.C.); Department of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia,..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gaetano M.","family":"De Ferrari","sequence":"additional","affiliation":[{"name":"From the TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women\u2019s Hospital, Harvard Medical School, Boston, MA (E.A.B., M.P.B., E.B., P.H., S.A.M., M.S.S., B.M.S., D.A.M.); South Australian Health and Research Institute, Flinders University and Medical Centre, Adelaide (P.E.A.); Division of Cardiovascular Diseases, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago (R.C.); Department of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia,..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ping","family":"He","sequence":"additional","affiliation":[{"name":"From the TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women\u2019s Hospital, Harvard Medical School, Boston, MA (E.A.B., M.P.B., E.B., P.H., S.A.M., M.S.S., B.M.S., D.A.M.); South Australian Health and Research Institute, Flinders University and Medical Centre, Adelaide (P.E.A.); Division of Cardiovascular Diseases, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago (R.C.); Department of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia,..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Basil S.","family":"Lewis","sequence":"additional","affiliation":[{"name":"From the TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women\u2019s Hospital, Harvard Medical School, Boston, MA (E.A.B., M.P.B., E.B., P.H., S.A.M., M.S.S., B.M.S., D.A.M.); South Australian Health and Research Institute, Flinders University and Medical Centre, Adelaide (P.E.A.); Division of Cardiovascular Diseases, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago (R.C.); Department of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia,..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Piera A.","family":"Merlini","sequence":"additional","affiliation":[{"name":"From the TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women\u2019s Hospital, Harvard Medical School, Boston, MA (E.A.B., M.P.B., E.B., P.H., S.A.M., M.S.S., B.M.S., D.A.M.); South Australian Health and Research Institute, Flinders University and Medical Centre, Adelaide (P.E.A.); Division of Cardiovascular Diseases, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago (R.C.); Department of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia,..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sabina A.","family":"Murphy","sequence":"additional","affiliation":[{"name":"From the TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women\u2019s Hospital, Harvard Medical School, Boston, MA (E.A.B., M.P.B., E.B., P.H., S.A.M., M.S.S., B.M.S., D.A.M.); South Australian Health and Research Institute, Flinders University and Medical Centre, Adelaide (P.E.A.); Division of Cardiovascular Diseases, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago (R.C.); Department of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia,..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc S.","family":"Sabatine","sequence":"additional","affiliation":[{"name":"From the TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women\u2019s Hospital, Harvard Medical School, Boston, MA (E.A.B., M.P.B., E.B., P.H., S.A.M., M.S.S., B.M.S., D.A.M.); South Australian Health and Research Institute, Flinders University and Medical Centre, Adelaide (P.E.A.); Division of Cardiovascular Diseases, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago (R.C.); Department of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia,..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin M.","family":"Scirica","sequence":"additional","affiliation":[{"name":"From the TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women\u2019s Hospital, Harvard Medical School, Boston, MA (E.A.B., M.P.B., E.B., P.H., S.A.M., M.S.S., B.M.S., D.A.M.); South Australian Health and Research Institute, Flinders University and Medical Centre, Adelaide (P.E.A.); Division of Cardiovascular Diseases, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago (R.C.); Department of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia,..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David A.","family":"Morrow","sequence":"additional","affiliation":[{"name":"From the TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women\u2019s Hospital, Harvard Medical School, Boston, MA (E.A.B., M.P.B., E.B., P.H., S.A.M., M.S.S., B.M.S., D.A.M.); South Australian Health and Research Institute, Flinders University and Medical Centre, Adelaide (P.E.A.); Division of Cardiovascular Diseases, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago (R.C.); Department of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia,..."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1097\/HPC.0b013e3181a84613"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1200933"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(12)61269-0"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.114.001505"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2009.06.027"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0b013e318277d6a0"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/eht296"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.109.852749"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.114.015042"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.284.7.835"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.102.17.2031"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.163.19.2345"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000133"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0b013e3182742c84"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehv320"}],"container-title":["Circulation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/CIRCULATIONAHA.115.019861","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T06:44:44Z","timestamp":1715582684000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/CIRCULATIONAHA.115.019861"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016,7,26]]},"references-count":15,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2016,7,26]]}},"alternative-id":["10.1161\/CIRCULATIONAHA.115.019861"],"URL":"https:\/\/doi.org\/10.1161\/circulationaha.115.019861","relation":{},"ISSN":["0009-7322","1524-4539"],"issn-type":[{"value":"0009-7322","type":"print"},{"value":"1524-4539","type":"electronic"}],"subject":[],"published":{"date-parts":[[2016,7,26]]},"assertion":[{"value":"2015-10-13","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2016-04-25","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2016-07-20","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}