| 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. | |
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MedLine Citation:
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PMID: 21060072 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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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:
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Type: Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't Date: 2010-11-08 |
Journal Detail:
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Title: Circulation Volume: 122 ISSN: 1524-4539 ISO Abbreviation: Circulation Publication Date: 2010 Nov |
Date Detail:
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Created Date: 2010-11-24 Completed Date: 2010-12-28 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0147763 Medline TA: Circulation Country: United States |
Other Details:
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Languages: eng Pagination: 2131-41 Citation Subset: AIM; IM |
Affiliation:
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INSERM U, Paris, France. gabriel.steg@bch.aphp.fr |
| Data Bank Information | |
Bank Name/Acc. No.:
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ClinicalTrials.gov/NCT00391872 |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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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:
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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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