Extent of coronary artery disease and outcomes after ticagrelor administration in patients with an acute coronary syndrome: Insights from the PLATelet inhibition and patient Outcomes (PLATO) trial.

Kotsia, Anna; Brilakis, Emmanouil S; Held, Claes; Cannon, Christopher; Steg, Gabriel P; Meier, Bernhard; Cools, Frank; Claeys, Marc J; Cornel, Jan H; Aylward, Philip; Lewis, Basil S; Weaver, Douglas; Brandrup-Wognsen, Gunnar; Stevens, Susanna R; Himmelmann, Anders; Wallentin, Lars; James, Stefan K (2014). Extent of coronary artery disease and outcomes after ticagrelor administration in patients with an acute coronary syndrome: Insights from the PLATelet inhibition and patient Outcomes (PLATO) trial. American Heart Journal, 168(1), 68-75.e2. Elsevier 10.1016/j.ahj.2014.04.001

[img] Text
1-s2.0-S0002870314002105-main.pdf - Published Version
Restricted to registered users only
Available under License Publisher holds Copyright.

Download (518kB) | Request a copy

BACKGROUND Extensive coronary artery disease (CAD) is associated with higher risk. In this substudy of the PLATO trial, we examined the effects of randomized treatment on outcome events and safety in relation to the extent of CAD. METHODS Patients were classified according to presence of extensive CAD (defined as 3-vessel disease, left main disease, or prior coronary artery bypass graft surgery). The trial's primary and secondary end points were compared using Cox proportional hazards regression. RESULTS Among 15,388 study patients for whom the extent of CAD was known, 4,646 (30%) had extensive CAD. Patients with extensive CAD had more high-risk characteristics and experienced more clinical events during follow-up. They were less likely to undergo percutaneous coronary intervention (58% vs 79%, P < .001) but more likely to undergo coronary artery bypass graft surgery (16% vs 2%, P < .001). Ticagrelor, compared with clopidogrel, reduced the composite of cardiovascular death, myocardial infarction, and stroke in patients with extensive CAD (14.9% vs 17.6%, hazard ratio [HR] 0.85 [0.73-0.98]) similar to its reduction in those without extensive CAD (6.8% vs 8.0%, HR 0.85 [0.74-0.98], Pinteraction = .99). Major bleeding was similar with ticagrelor vs clopidogrel among patients with (25.7% vs 25.5%, HR 1.02 [0.90-1.15]) and without (7.3% vs 6.4%, HR 1.14 [0.98-1.33], Pinteraction = .24) extensive CAD. CONCLUSIONS Patients with extensive CAD have higher rates of recurrent cardiovascular events and bleeding. Ticagrelor reduced ischemic events to a similar extent both in patients with and without extensive CAD, with bleeding rates similar to clopidogrel.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology

UniBE Contributor:

Meier, Bernhard

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0002-8703

Publisher:

Elsevier

Language:

English

Submitter:

Daria Vogelsang

Date Deposited:

09 Feb 2015 14:08

Last Modified:

29 Oct 2015 10:44

Publisher DOI:

10.1016/j.ahj.2014.04.001

PubMed ID:

24952862

BORIS DOI:

10.7892/boris.63018

URI:

https://boris.unibe.ch/id/eprint/63018

Actions (login required)

Edit item Edit item
Provide Feedback