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

J 2024

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

LATTUCA, Benoit, Cedric MAZEAU, Guillaume CAYLA, Gregory DUCROCQ, Paul GUEDENEY et. al.

Basic information

Original name

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

Authors

LATTUCA, Benoit, Cedric MAZEAU, Guillaume CAYLA, Gregory DUCROCQ, Paul GUEDENEY, Mikael LAREDO, Raphaelle DUMAINE, El Kasty MOHAMAD, Petr KALA (203 Czech Republic, belonging to the institution), 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 and Johanne SILVAIN

Edition

JACC - Cardiovascular Interventions, New York, Elsevier Science Inc. 2024, 1936-8798

Other information

Language

English

Type of outcome

Článek v odborném periodiku

Field of Study

30201 Cardiac and Cardiovascular systems

Country of publisher

United States of America

Confidentiality degree

není předmětem státního či obchodního tajemství

References:

URL

Impact factor

Impact factor: 11.300 in 2022

Organization unit

Faculty of Medicine

DOI

http://dx.doi.org/10.1016/j.jcin.2023.12.011

UT WoS

001183381000001

Keywords in English

chronic coronary syndrome; complex percutaneous coronary; intervention; coronary artery disease; myocardial infarction; ticagrelor

Abstract

V originále

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.

Citovat

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 and Johanne SILVAIN. Ticagrelor vs Clopidogrel for Complex Percutaneous Coronary Intervention in Chronic Coronary Syndrome. JACC - Cardiovascular Interventions. New York: Elsevier Science Inc., 2024, vol. 17, No 3, p. 359-370. ISSN 1936-8798. Available from: https://dx.doi.org/10.1016/j.jcin.2023.12.011.

@article{2424197,
   author = {Lattuca, Benoit and Mazeau, Cedric and Cayla, Guillaume and Ducrocq, Gregory and Guedeney, Paul and Laredo, Mikael and Dumaine, Raphaelle and Mohamad, El Kasty and Kala, Petr and Nejjari, Mohammed and Hlinomaz, Ota and Morel, Olivier and Leclercq, Florence and Payot, Laurent and Spaulding, Christian and Beygui, Farzin and Range, Gregoire and Motovska, Zuzana and Portal, Jean andJacques and Vicaut, Eric and Collet, Jean andPhilippe and Montalescot, Gilles and Silvain, Johanne},
   article_location = {New York},
   article_number = {3},
   doi = {http://dx.doi.org/10.1016/j.jcin.2023.12.011},
   keywords = {chronic coronary syndrome; complex percutaneous coronary; intervention; coronary artery disease; myocardial infarction; ticagrelor},
   language = {eng},
   issn = {1936-8798},
   journal = {JACC - Cardiovascular Interventions},
   title = {Ticagrelor vs Clopidogrel for Complex Percutaneous Coronary Intervention in Chronic Coronary Syndrome},
   url = {https://www.sciencedirect.com/science/article/abs/pii/S1936879823016242?via%3Dihub},
   volume = {17},
   year = {2024}
}

TY  - JOUR
ID  - 2424197
AU  - Lattuca, Benoit - Mazeau, Cedric - Cayla, Guillaume - Ducrocq, Gregory - Guedeney, Paul - Laredo, Mikael - Dumaine, Raphaelle - Mohamad, El Kasty - Kala, Petr - Nejjari, Mohammed - Hlinomaz, Ota - Morel, Olivier - Leclercq, Florence - Payot, Laurent - Spaulding, Christian - Beygui, Farzin - Range, Gregoire - Motovska, Zuzana - Portal, Jean -Jacques - Vicaut, Eric - Collet, Jean -Philippe - Montalescot, Gilles - Silvain, Johanne
PY  - 2024
TI  - Ticagrelor vs Clopidogrel for Complex Percutaneous Coronary Intervention in Chronic Coronary Syndrome
JF  - JACC - Cardiovascular Interventions
VL  - 17
IS  - 3
SP  - 359-370
EP  - 359-370
PB  - Elsevier Science Inc.
SN  - 19368798
KW  - chronic coronary syndrome
KW  - complex percutaneous coronary
KW  - intervention
KW  - coronary artery disease
KW  - myocardial infarction
KW  - ticagrelor
UR  - https://www.sciencedirect.com/science/article/abs/pii/S1936879823016242?via%3Dihub
N2  - 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.
ER  -

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 and Johanne SILVAIN. Ticagrelor vs Clopidogrel for Complex Percutaneous Coronary Intervention in Chronic Coronary Syndrome. \textit{JACC - Cardiovascular Interventions}. New York: Elsevier Science Inc., 2024, vol.~17, No~3, p.~359-370. ISSN~1936-8798. Available from: https://dx.doi.org/10.1016/j.jcin.2023.12.011.

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