J 2017

Relative efficacy and safety of ticagelor vs clopidogrel as a function of time to invasive management in non-ST-segment elevation acute coronary syndrome in the PLATO trial

POLLACK, C.V., F. DAVOUDI, D.B. DIERCKS, R.C. BECKER, S.K. JAMES et. al.

Basic information

Original name

Relative efficacy and safety of ticagelor vs clopidogrel as a function of time to invasive management in non-ST-segment elevation acute coronary syndrome in the PLATO trial

Authors

POLLACK, C.V. (840 United States of America), F. DAVOUDI (840 United States of America), D.B. DIERCKS (840 United States of America), R.C. BECKER (840 United States of America), S.K. JAMES (752 Sweden), S.T. LIM (702 Singapore), P.J. SCHULTE (840 United States of America), Jindřich ŠPINAR (203 Czech Republic, guarantor, belonging to the institution), P.G. STEG (250 France), R.F. STOREY (840 United States of America), A. HIMMELMANN (752 Sweden), L. WALLENTIN (752 Sweden) and C.P. CANNON (840 United States of America)

Edition

Clinical Cardiology, Hoboken, John Wiley and Sons Inc. 2017, 0160-9289

Other information

Language

English

Type of outcome

Article in a journal

Field of Study

30201 Cardiac and Cardiovascular systems

Country of publisher

United States of America

Confidentiality degree

is not subject to a state or trade secret

Impact factor

Impact factor: 2.733

RIV identification code

RIV/00216224:14110/17:00097701

Organization unit

Faculty of Medicine

DOI

UT WoS

000405393200007

Keywords in English

Non-ST-Segment Elevation Acute Coronary Syndromes (NSTE-ACS); Antiplatelet Therapy; P2Y(12) Receptor Antagonists; Clopidogrel; Ticagrelor; Angiography

Tags

Tags

International impact, Reviewed
Changed: 13/3/2018 19:00, Soňa Böhmová

Abstract

V originále

Background: Guidelines suggest that "upstream" P2Y(12) receptor antagonists should be considered in patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACS). Hypothesis: Early use of ticagrelor in patients managed with an invasive strategy would be more effective than clopidogrel because of its more rapid onset of action and greater potency. Methods: In the PLATO trial, 6792 NSTE-ACS patients were randomized to ticagrelor or clopidogrel (started prior to angiography) and underwent angiography within 72 hours of randomization. We compared efficacy and safety outcomes of ticagrelor vs clopidogrel as a function of "early" (<3h) vs "late" (>= 3h) time to angiography. Adjusted Cox proportional hazards models evaluated interaction between randomized treatment and time from randomization to angiography on subsequent outcomes. Results: Overall, a benefit of ticagrelor vs clopidogrel for cardiovascular death/myocardial infarction/stroke was seen at day 7 (hazard ratio [HR]: 0.67, P = 0.002), day 30 (HR: 0.81, P = 0.042), and 1 year (HR: 0.80, P = 0.0045). There were no significant interactions in the <3h vs >= 3h groups at any timepoint. For major bleeding, overall there was no significant increase (HR: 1.04, 95% confidence interval: 0.85-1.27); but there was a significant interaction with no difference between ticagrelor and clopidogrel in the early group (HR: 0.79), but higher bleeding risk with ticagrelor in the late angiography group, at 7 days (HR: 1.51, P-int = 0.002). Patterns were similar at 30 days and 1 year. Conclusions: The benefit of ticagrelor over clopidogrel was consistent in those undergoing early and late angiography, supporting upstream use of ticagrelor