Ticagrelor vs Clopidogrel for Complex Percutaneous Coronary Intervention in Chronic Coronary Syndrome

LATTUCA, Benoit, Cedric MAZEAU, Guillaume CAYLA, Gregory DUCROCQ, Paul GUEDENEY, Mikael LAREDO, Raphaelle DUMAINE, El Kasty MOHAMAD, Petr KALA, Mohammed NEJJARI, Ota HLINOMAZ, Olivier MOREL, Florence LECLERCQ, Laurent PAYOT, Christian SPAULDING, Farzin BEYGUI, Gregoire RANGE, Zuzana MOTOVSKA, Jean -Jacques PORTAL, Eric VICAUT, Jean -Philippe COLLET, Gilles MONTALESCOT a Johanne SILVAIN. Ticagrelor vs Clopidogrel for Complex Percutaneous Coronary Intervention in Chronic Coronary Syndrome. JACC - Cardiovascular Interventions. New York: Elsevier Science Inc., 2024, roč. 17, č. 3, s. 359-370. ISSN 1936-8798. Dostupné z: https://dx.doi.org/10.1016/j.jcin.2023.12.011.

Základní údaje

• Originální název: Ticagrelor vs Clopidogrel for Complex Percutaneous Coronary Intervention in Chronic Coronary Syndrome
• Autoři: LATTUCA, Benoit, Cedric MAZEAU, Guillaume CAYLA, Gregory DUCROCQ, Paul GUEDENEY, Mikael LAREDO, Raphaelle DUMAINE, El Kasty MOHAMAD, Petr KALA (203 Česká republika, domácí), Mohammed NEJJARI, Ota HLINOMAZ, Olivier MOREL, Florence LECLERCQ, Laurent PAYOT, Christian SPAULDING, Farzin BEYGUI, Gregoire RANGE, Zuzana MOTOVSKA, Jean -Jacques PORTAL, Eric VICAUT, Jean -Philippe COLLET, Gilles MONTALESCOT a Johanne SILVAIN.
• Vydání: JACC - Cardiovascular Interventions, New York, Elsevier Science Inc. 2024, 1936-8798.

Další údaje

• Originální jazyk: angličtina
• Typ výsledku: Článek v odborném periodiku
• Obor: 30201 Cardiac and Cardiovascular systems
• Stát vydavatele: Spojené státy
• Utajení: není předmětem státního či obchodního tajemství
• WWW: URL
• Impakt faktor: Impact factor: 11.300 v roce 2022
• Organizační jednotka: Lékařská fakulta
• Doi: http://dx.doi.org/10.1016/j.jcin.2023.12.011
• UT WoS: 001183381000001
• Klíčová slova anglicky: chronic coronary syndrome; complex percutaneous coronary; intervention; coronary artery disease; myocardial infarction; ticagrelor
• Štítky: 14110211, rivok
• Příznaky: Mezinárodní význam, Recenzováno

Anotace

BACKGROUND Whether ticagrelor in chronic coronary syndrome patients undergoing complex percutaneous coronary intervention (PCI) can prevent cardiovascular events is unknown. OBJECTIVES The authors sought to evaluate outcomes of complex PCI and the efficacy of ticagrelor vs clopidogrel in stable patients randomized in the ALPHEUS (Assessment of Loading with the P2Y(12) inhibitor ticagrelor or clopidogrel to Halt ischemic Events in patients Undergoing elective coronary Stenting) trial. METHODS All PCI procedures were blindly reviewed and classified as complex if they had at least 1 of the following criteria: stent length >60 mm, 2-stent bifurcation, left main, bypass graft, chronic total occlusion, use of atherectomy or guiding catheter extensions, multiwire technique, multiple stents. The primary endpoint was a composite of type 4a or b myocardial infarction (MI) and major myocardial injury during the 48 hours after PCI. We compared the event rates according to the presence or not of complex PCI criteria and evaluated the interaction with ticagrelor or clopidogrel. RESULTS Among the 1,866 patients randomized, 910 PCI (48.3%) were classified as complex PCI. The primary endpoint was more frequent in complex PCI (45.6% vs 26.6%; P < 0.001) driven by higher rates of type 4 MI and angiographic complications (12.2% vs 4.8 %; P < 0.001 and 19.3% vs 8.6%; P < 0.05, respectively). The composite of death, MI, and stroke at 48 hours (12.7% vs 5.1 %; P < 0.05) and at 30 days (13.4% vs 5.3%; P < 0.05) was more frequent in complex PCI. No interaction was found between PCI complexity and the randomized treatment for the primary endpoint (P-interaction 1/4 0.47) nor the secondary endpoints. CONCLUSIONS In chronic coronary syndrome, patients undergoing a complex PCI have higher rates of periprocedural and cardiovascular events that are not reduced by ticagrelor as compared with clopidogrel. (J Am Coll Cardiol Intv 2024;17:359-370) (c) 2024 by the American College of Cardiology Foundation.