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Cardiovascular events in acute coronary syndrome patients with peripheral arterial disease treated with ticagrelor compared with clopidogrel: Data from the PLATO Trial
Journal article   Open access   Peer reviewed

Cardiovascular events in acute coronary syndrome patients with peripheral arterial disease treated with ticagrelor compared with clopidogrel: Data from the PLATO Trial

Manesh R Patel, Richard C Becker, Daniel M Wojdyla, Hakan Emanuelsson, William R Hiatt, Jay Horrow, Steen Husted, Kenneth W Mahaffey, P Gabriel Steg, Robert F Storey, …
European journal of preventive cardiology, v 22(6), pp 734-742
01 Jun 2015
DOI: https://doi.org/10.1177/2047487314533215
PMID: 24830710
Featured in Collection :   UN Sustainable Development Goals @ Drexel
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https://doi.org/10.1177/2047487314533215View
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Abstract

Acute Coronary Syndrome - complications Acute Coronary Syndrome - diagnosis Acute Coronary Syndrome - drug therapy Acute Coronary Syndrome - mortality Adenosine - adverse effects Adenosine - analogs & derivatives Adenosine - therapeutic use Aged Double-Blind Method Female Hemorrhage - chemically induced Humans Kaplan-Meier Estimate Male Middle Aged Myocardial Infarction - etiology Myocardial Infarction - mortality Myocardial Infarction - prevention & control Peripheral Arterial Disease - complications Peripheral Arterial Disease - diagnosis Peripheral Arterial Disease - mortality Platelet Aggregation Inhibitors - adverse effects Platelet Aggregation Inhibitors - therapeutic use Proportional Hazards Models Risk Factors Stroke - etiology Stroke - mortality Stroke - prevention & control Ticlopidine - adverse effects Ticlopidine - analogs & derivatives Ticlopidine - therapeutic use Time Factors Treatment Outcome
To determine the effect of ticagrelor compared to clopidogrel in patients with peripheral artery disease (PAD) and acute coronary syndromes (ACS). PLATO (n = 18,624) was a multicentre, double-blind, randomized trial in ACS, that showed a 16% reduction in cardiovascular death (CV-death), myocardial infarction (MI) and stroke with ticagrelor compared with clopidogrel, without significant increase in overall major bleeding. We performed a post-hoc analysis of cardiovascular and bleeding outcomes in PLATO according to reported PAD status at baseline. At one year, CV death, MI or stroke occurred in 19.3% of patients with PAD (n = 1144) compared to 10.2% in patients without PAD (p < 0.001). The Kaplan-Meier one year event rate for the primary endpoint of CV death, MI or stroke in PAD patients treated with ticagrelor as compared with clopidogrel, was 18% vs 20.6% (HR: 0.85 95% CI 0.64-1.11; for PAD status by treatment interaction, p = 0.99) and for death from any cause 8.7% vs 11.9%, (HR: 0.74 95% CI 0.50-1.08; interaction p = 0.73). PLATO-defined major bleeding event rates at one year were 14.8% for ticagrelor compared to 17.9% for clopidogrel, (HR: 0.81 95% CI 0.59-1.10; interaction p = 0.09). PAD patients have a high rate of ischaemic and bleeding events post ACS. The reduction of CV death, MI or stroke with ticagrelor compared with clopidogrel in PAD patients was consistent with the overall trial result although it did not reach statistical significance. Overall major bleeding was similar between the therapies.

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Cardiac & Cardiovascular Systems
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