Ticagrelor versus clopidogrel in patients with ST-elevation acute coronary
syndromes intended for reperfusion with primary percutaneous coronary
intervention: A Platelet Inhibition and Patient Outcomes (PLATO) trial subgroup
analysis.
Author(s): Steg PG, James S, Harrington RA, Ardissino D, Becker RC, Cannon CP, Emanuelsson
H, Finkelstein A, Husted S, Katus H, Kilhamn J, Olofsson S, Storey RF, Weaver WD,
Wallentin L; PLATO Study Group.
Affiliation(s): INSERM U, Paris, France. gabriel.steg@bch.aphp.fr
Publication date & source: 2010, Circulation. , 122(21):2131-41
BACKGROUND: Aspirin and clopidogrel are recommended for patients with acute
coronary syndromes (ACS) or undergoing coronary stenting. Ticagrelor, a
reversible oral P2Y12-receptor antagonist, provides faster, greater, and more
consistent platelet inhibition than clopidogrel and may be useful for patients
with acute ST-segment elevation (STE) ACS and planned primary percutaneous
coronary intervention.
METHODS AND RESULT: Platelet Inhibition and Patient Outcomes (PLATO), a
randomized, double-blind trial, compared ticagrelor with clopidogrel for the
prevention of vascular events in 18 624 ACS patients. This report concerns the
7544 ACS patients with STE or left bundle-branch block allocated to either
ticagrelor 180-mg loading dose followed by 90 mg twice daily or clopidogrel
300-mg loading dose (with provision for 300 mg clopidogrel at percutaneous
coronary intervention) followed by 75 mg daily for 6 to 12 months. The reduction
of the primary end point (myocardial infarction, stroke, or cardiovascular death)
with ticagrelor versus clopidogrel (10.8% versus 9.4%; hazard ratio [HR], 0.87;
95% confidence interval, 0.75 to 1.01; P=0.07) was consistent with the overall
PLATO results. There was no interaction between presentation with STE/left
bundle-branch block and randomized treatment (interaction P=0.29). Ticagrelor
reduced several secondary end points, including myocardial infarction alone (HR,
0.80; P=0.03), total mortality (HR, 0.82; P=0.05), and definite stent thrombosis
(HR, 0.66; P=0.03). The risk of stroke, low in both groups, was higher with
ticagrelor (1.7% versus 1.0%; HR,1.63; 95% confidence interval, 1.07 to 2.48;
P=0.02). Ticagrelor did not affect major bleeding (HR, 0.98; P=0.76).
CONCLUSION: In patients with STE-ACS and planned primary percutaneous coronary
intervention, the effects of ticagrelor were consistent with those observed in
the overall PLATO trial.
CLINICAL TRIAL REGISTRATION: URL: http://www.ClinicalTrials.gov. Unique
identifier: NCT00391872.
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