Document Detail


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.
MedLine Citation:
PMID:  21060072     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
Philippe Gabriel Steg; Stefan James; Robert A Harrington; Diego Ardissino; Richard C Becker; Christopher P Cannon; Håkan Emanuelsson; Ariel Finkelstein; Steen Husted; Hugo Katus; Jan Kilhamn; Sylvia Olofsson; Robert F Storey; W Douglas Weaver; Lars Wallentin;
Publication Detail:
Type:  Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't     Date:  2010-11-08
Journal Detail:
Title:  Circulation     Volume:  122     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2010 Nov 
Date Detail:
Created Date:  2010-11-24     Completed Date:  2010-12-28     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2131-41     Citation Subset:  AIM; IM    
Affiliation:
INSERM U, Paris, France. gabriel.steg@bch.aphp.fr
Data Bank Information
Bank Name/Acc. No.:
ClinicalTrials.gov/NCT00391872
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MeSH Terms
Descriptor/Qualifier:
Acute Coronary Syndrome / diagnosis,  drug therapy*,  epidemiology
Adenosine / administration & dosage,  adverse effects,  analogs & derivatives*
Aged
Angioplasty, Balloon, Coronary*
Coronary Thrombosis / epidemiology,  prevention & control*
Electrocardiography
Female
Hemorrhage / chemically induced,  epidemiology
Humans
Kaplan-Meier Estimate
Male
Middle Aged
Platelet Aggregation Inhibitors / administration & dosage*,  adverse effects
Purinergic P2Y Receptor Antagonists / administration & dosage,  adverse effects
Risk Factors
Ticlopidine / administration & dosage,  adverse effects,  analogs & derivatives*
Treatment Outcome
Chemical
Reg. No./Substance:
0/Platelet Aggregation Inhibitors; 0/Purinergic P2Y Receptor Antagonists; 0/Ticagrelor; 55142-85-3/Ticlopidine; 58-61-7/Adenosine; 90055-48-4/clopidogrel

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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