Quantitative ST-depression in Acute Coronary Syndromes: the PLATO Electrocardiographic Substudy - 23/07/13
, Cynthia M. Westerhout, PhD a, Yuling Fu, MD a, Robert A. Harrington, MD b, Robert F. Storey, MD, DM c, Hugo Katus, MD d, Stefan James, MD, PhD e, f, g, Lars Wallentin, MD, PhD gAbstract |
Background |
We evaluated whether electrocardiogram (ECG) characteristics were aligned with clinical outcomes and the effect of ticagrelor within the diverse spectrum of non-ST-elevation acute coronary syndrome patients enrolled in the PLATelet inhibition and patient Outcomes (PLATO) trial.
Methods |
There were 8884 PLATO patients who had baseline ECGs assessed by a core laboratory; of these, 4935 had an ECG at hospital discharge that also was assessed. Associations with study treatment on vascular death or myocardial infarction within 1 year were examined.
Results |
At baseline, most patients had either no or ≤0.5 mm of ST-segment depression (57%); 26% had 1.0 mm, and 17% had more extensive depression (>1.0 mm). Across the baseline ST-segment depression strata, there was a consistent treatment benefit with ticagrelor versus clopidogrel on vascular death/myocardial infarction. The extent of residual ST-segment depression at discharge was similar in the treatment groups, and the treatment effect did not differ by the extent of discharge ST-segment depression. There was a progressive increase in vascular death/myocardial infarction with increasing extent of baseline ST-segment depression (1.0 mm [vs no/0.5 mm]: hazard ratio [HR] 1.22; 95% confidence interval [CI], 1.03-1.45; >1.0 mm: HR 1.49; 95% CI, 1.24-1.78; P <.001) and at discharge (HR 1.28; 95% CI, 1.02-1.61; HR 2.13; 95% CI, 1.54-2.95; P <.001).
Conclusion |
The treatment effect of ticagrelor among non-ST-segment-elevation acute coronary syndrome patients was consistently expressed across all baseline ST-segment depression strata. There was no indication of an anti-ischemic benefit of ticagrelor as reflected on the discharge ECG. Our data affirm the independent prognostic relationship of both baseline and hospital discharge ST-segment depression on outcomes within 1 year in non-ST-segment-elevation acute coronary syndrome patients.
Le texte complet de cet article est disponible en PDF.Keywords : Acute coronary syndrome, Electrocardiography, Platelet inhibition
Plan
| Funding: The PLATO trial was supported by AstraZeneca. |
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| Conflict of Interest: PWA reports consulting fees from Merck and Company Inc., Eli Lilly, F. Hoffman La Roche Ltd, GlaxoSmithKline, AstraZeneca, and Axio/Orexigen; payment for development of educational presentations from Eli Lilly; and grants/grants pending to his institution from AstraZeneca, GlaxoSmithKline, F. Hoffman La Roche Ltd, Amylin Pharmaceuticals in conjunction with DCRI, Sanofi-Aventis Canada, Boehringer Ingelheim, and Merck & Company Inc. |
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| RAH reports consulting fees and advisory board fees from Bristol-Myers Squibb, Sanofi-Aventis, Portola Pharmaceuticals, Schering-Plough, AstraZeneca, Novartis, and Merck; lecture fees from Schering-Plough, Bristol-Myers Squibb, Sanofi-Aventis, and Eli Lilly; grant support from Millennium Pharmaceuticals, Schering-Plough, The Medicine Co., Merck, Portola Pharmaceuticals, AstraZeneca, and Bristol-Myers Squibb; and honoraria from Eli Lilly and The Medicines Co. |
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| RFS reports consultant fees from AstraZeneca, Accumetrics, Eli Lilly/Daiichi Sankyo, Novartis, Merck, Eisai, Sanofi Aventis/Regeneron, Bristol Myers Squibb, and The Medicines Co.; payment for lectures, including service on speakers bureaus, from AstraZeneca, Iroko, Merck, and Medscape; payment for manuscript preparation from AstraZeneca; grants/grants pending to his institution from Accumetrics, AstraZeneca, Eli Lilly/Daiichi Sankyo, and Merck; and consultant fees to his institution from Accumetrics. |
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| HK reports honoraria from Eli Lilly, GlaxoSmithKline, Roche, and Bayer; and holds a patent jointly with Roche for which he receives a royalty. |
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| SJ reports research grants, consulting and advisory board fees from AstraZeneca and honoraria from AstraZeneca, Bristol-Myers Squibb, Schering-Plough, and Eli Lilly. |
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| LW reports institutional research grants/grants pending from AstraZeneca, Boehringer Ingelheim, Bristol-Myers Squibb, GlaxoSmithKline, and Schering-Plough; honoraria to his institution from Schering-Plough/Merck; support to his institution for travel to study-related meetings from Schering-Plough/Merck and Bristol-Myers Squibb; consultant fees to his institution from Bristol/Myers Squibb/Pfizer; payments to his institution for lectures including service on speakers bureaus from AstraZeneca, Boehringer Ingelheim, Bristol-Myers Squibb, GlaxoSmithKline, and Schering-Plough/Merck; honoraria from AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, Schering-Plough; consultant fees from Regado, Athera, Portola, C.S.L Behring, Boehringer Ingelheim, AstraZeneca, Evolva, Bristol-Myers Squibb, and GlaxoSmithKline. |
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| The other authors have no conflicts to report. |
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| Authorship: All authors had access to the data and played a role in writing this manuscript. |
Vol 126 - N° 8
P. 723 - août 2013 Retour au numéro
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