Ticagrelor versus clopidogrel in patients with symptomatic peripheral artery disease and prior coronary artery disease: Insights from the EUCLID trial.

Berger, Jeffrey S; Abramson, Beth L; Lopes, Renato D; Heizer, Gretchen; Rockhold, Frank W; Baumgartner, Iris; Fowkes, F Gerry R; Held, Peter; Katona, Brian G; Norgren, Lars; Jones, W Schuyler; Millegård, Marcus; Blomster, Juuso; Reist, Craig; Hiatt, William R; Patel, Manesh R; Mahaffey, Kenneth W (2018). Ticagrelor versus clopidogrel in patients with symptomatic peripheral artery disease and prior coronary artery disease: Insights from the EUCLID trial. Vascular medicine, 23(6), pp. 523-530. Sage 10.1177/1358863X18775594

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Patients with peripheral artery disease (PAD) are at heightened risk of cardiovascular morbidity and mortality. We sought to evaluate the risk of concomitant coronary artery disease (CAD) in patients with symptomatic PAD versus PAD without diagnosed CAD, and whether ticagrelor was superior to clopidogrel in reducing that risk. The EUCLID trial randomized 13,885 patients with PAD to antithrombotic monotherapy with ticagrelor or clopidogrel. CAD was defined as prior myocardial infarction (MI), percutaneous coronary intervention (PCI), or coronary artery bypass graft (CABG) surgery. Median follow-up was 30 months. Among 4032 (29%) patients with PAD and CAD, 63% had prior MI, 54% prior PCI, and 38% prior CABG. After adjustment for baseline characteristics, patients with PAD and CAD had significantly higher rates of the primary endpoint (cardiovascular death/MI/stroke, 15.3% vs 8.9%, hazard ratio (HR) 1.50, 95% CI: 1.13-1.99; p=0.005), but no statistically significant increase in acute limb ischemia (HR 1.28, 95% CI: 0.57-2.85; p=0.55) or major bleeding (HR 1.10, 95% CI: 0.49-2.48; p=0.81) versus PAD without CAD. Among patients with PAD and CAD, there was no differential treatment effect between ticagrelor versus clopidogrel for the primary efficacy endpoint (HR 1.02, 95% CI: 0.87-1.19; p=0.84), acute limb ischemia (HR 1.03, 95% CI: 0.63-1.69; p=0.89), or major bleeding (HR 1.06, 95% CI: 0.66-1.69; p=0.81). There was a statistically significant interaction between prior coronary stent placement and study treatment ( p=0.03) with a numerical reduction in the primary efficacy endpoint with ticagrelor versus clopidogrel (13.8% vs 16.8%, HR 0.82, 95% CI: 0.65-1.03; p=0.09). Patients with PAD and prior CAD had higher composite rates of cardiovascular death, MI, and ischemic stroke versus PAD without diagnosed CAD. There were no significant differences between ticagrelor and clopidogrel in cardiovascular events or major bleeding. ClinicalTrials.gov Identifier: NCT01732822.

Item Type:	Journal Article (Original Article)
Division/Institute:	04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Angiology
UniBE Contributor:	Baumgartner, Iris
Subjects:	600 Technology > 610 Medicine & health
ISSN:	1358-863X
Publisher:	Sage
Language:	English
Submitter:	Catherine Gut
Date Deposited:	11 Feb 2019 17:49
Last Modified:	05 Dec 2022 15:24
Publisher DOI:	10.1177/1358863X18775594
PubMed ID:	29992857
Uncontrolled Keywords:	acute limb ischemia antiplatelet therapy cardiovascular events coronary artery disease major bleeding peripheral artery disease (PAD) ticagrelor
URI:	https://boris.unibe.ch/id/eprint/123386