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 - 19/06/14
, Claes Held, MD, PhD b, Christopher Cannon, MD c, Gabriel P. Steg, MD d, e, f, g, Bernhard Meier, MD h, Frank Cools, MD i, Marc J. Claeys, MD, PhD j, Jan H. Cornel, MD, PhD k, Philip Aylward, BM, BCh, PhD l, Basil S. Lewis, MD m, Douglas Weaver, MD n, Gunnar Brandrup-Wognsen, MD, PhD o, Susanna R. Stevens, MSc p, Anders Himmelmann, MD, PhD o, Lars Wallentin, MD, PhD b, Stefan K. James, MD, PhD bRésumé |
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.
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| Clinical Trial registration: www.clinicaltrials.gov; NCT00391872. |
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| Gregory W. Barsness, MD, served as guest editor for this article. |
Vol 168 - N° 1
P. 68 - juillet 2014 Retour au numéro
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