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Stent thrombosis with ticagrelor versus clopidogrel in patients with acute coronary syndromes

Background— - - We aimed to describe the effects of ticagrelor versus clopidogrel on stent thrombosis in the Platelet Inhibition and Patient Outcomes (PLATO) trial. - - Methods and Results— - - Of 18 624 patients hospitalized for acute coronary syndromes, 11 289 (61%) had at least 1 intracoronary...

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Main Authors: Steg, P. Gabriel (Author) , Harrington, Robert A. (Author) , Emanuelsson, Håkan (Author) , Katus, Hugo (Author) , Mahaffey, Kenneth W. (Author) , Meier, Bernhard (Author) , Storey, Robert F. (Author) , Wojdyla, Daniel M. (Author) , Lewis, Basil S. (Author) , Maurer, Gerald (Author) , Wallentin, Lars (Author) , James, Stefan K. (Author)
Format: Article (Journal)
Language:English
Published: 2013
In: Circulation
Year: 2013, Volume: 128, Issue: 10, Pages: 1055-1065
ISSN:1524-4539
DOI:10.1161/CIRCULATIONAHA.113.002589
Online Access:Verlag, lizenzpflichtig, Volltext: https://doi.org/10.1161/CIRCULATIONAHA.113.002589
Verlag, lizenzpflichtig, Volltext: https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.113.002589
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Author Notes:P. Gabriel Steg, Robert A. Harrington, Håkan Emanuelsson, Hugo A. Katus, Kenneth W. Mahaffey, Bernhard Meier, Robert F. Storey, Daniel M. Wojdyla, Basil S. Lewis, Gerald Maurer, Lars Wallentin, Stefan K. James for the PLATO Study Group
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Summary:Background— - - We aimed to describe the effects of ticagrelor versus clopidogrel on stent thrombosis in the Platelet Inhibition and Patient Outcomes (PLATO) trial. - - Methods and Results— - - Of 18 624 patients hospitalized for acute coronary syndromes, 11 289 (61%) had at least 1 intracoronary stent. Ticagrelor reduced stent thrombosis compared with clopidogrel across all definitions: definite, 1.37% (n=71) versus 1.93% (n=105; hazard ratio [HR], 0.67; 95% confidence interval [CI], 0.50-0.90; P=0.0091); definite or probable, 2.21% (n=118) versus 2.87% (n=157; HR, 0.75; 95% CI, 0.59-0.95; P=0.017); and definite, probable, and possible, 2.94% (n=154) versus 3.77 (n=201; HR, 0.77; 95% CI, 0.62-0.95). The reduction in definite stent thrombosis was consistent regardless of acute coronary syndrome type, presence of diabetes mellitus, stent type (drug-eluting or bare metal stent), CYP2C19 genetic status, loading dose of aspirin, dose of clopidogrel before randomization, and use of glycoprotein IIb/IIIa inhibitors at randomization. The reduction in stent thrombosis with ticagrelor was numerically greater for late (>30 days; HR, 0.48; 95% CI, 0.24-0.96) and subacute (4 hours-30 days; HR, 0.60; 95% CI, 0.39-0.93) compared with acute (<24 hours; HR, 0.94; 95% CI, 0.43-2.05) stent thrombosis or for patients compliant to therapy (ie, taking blinded study treatment ≥80% of the time) compared with less compliant patients. Randomization to ticagrelor was a strong independent inverse predictor of definite stent thrombosis (HR, 0.65; 95% CI, 0.48-0.88). - - Conclusion— - - Ticagrelor compared with clopidogrel reduces the incidence of stent thrombosis in patients with acute coronary syndromes, with consistent benefit across a broad range of patient, stent, and treatment characteristics. - - Clinical Trial Registration— - - URL: http://www.clinicaltrials.gov. Unique identifier: NCT00391872.
Item Description:Gesehen am 15.02.2022
Physical Description:Online Resource
ISSN:1524-4539
DOI:10.1161/CIRCULATIONAHA.113.002589

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