DIAMOND - Dual Antiplatelet Therapy to Reduce Myocardial Injury

Inclusion Criteria: * Patients aged ≥40 years with angiographically proven multivessel coronary artery disease defined as at least two major epicardial vessels with any combination of either (a) \>50% luminal stenosis, or (b) previous revascularization (percutaneous coronary intervention or coronary artery bypass graft surgery). * Provision of informed consent prior to any study specific procedures Exclusion Criteria: * An acute coronary syndrome within the last 12 months * An indication for dual anti-platelet therapy, such as drug eluting stent * Inability to take aspirin * Receiving thienopyridine therapy such as clopidogrel or prasugrel * Percutaneous coronary intervention or coronary artery bypass graft surgery within the last 3 months * Inability or unwilling to give informed consent * Woman with child-bearing potential and who are breastfeeding will not be enrolled into the trial (woman who have experienced menarche, are pre-menopausal, have not been sterilised or who are currently pregnant) * Known hypersensitivity to ticagrelor or one of its excipients * Active pathological bleeding or bleeding diathesis * Significant thrombocytopenia: \<100 x 10\^9 /L * History of intracranial haemorrhage * Moderate to severe liver impairment (Child's Grade B or C) * Maintenance therapy with strong cytochrome P450 3A4 (CYP3A4) inhibitors, such as ketoconazole, nefazodone, ritonavir, indinavir, atazanavir, or clarithromycin * Major intercurrent illness or life expectancy \<1 year * Renal dysfunction (eGFR ≤30 mL/min/1.73 m2) * Contraindication to iodinated contrast agents * Planned coronary revascularization or major non-cardiac surgery in the next 12 months * Maintenance therapy with simvastatin at doses greater than 40mg daily * Receiving oral anticoagulants including warfarin, rivaroxaban, dabigatran or apixaban.