Journal article
ST-Elevation Acute Coronary Syndromes in the Platelet Inhibition and Patient Outcomes (PLATO) Trial Insights From the ECG Substudy
Circulation (New York, N.Y.), v 125(3), pp 514-U131
24 Jan 2012
PMID: 22179530
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Background-Ticagrelor, when compared with clopidogrel, reduced the 12-month risk of vascular death/myocardial infarction and stroke in patients with ST-elevation acute coronary syndromes intended to undergo primary percutaneous coronary intervention in the PLATelet inhibition and patient Outcomes (PLATO) trial. This prespecified ECG substudy explored whether ticagrelor's association with vascular death and myocardial infarction within 1 year would be amplified by (1) the extent of baseline ST shift and (2) subsequently associated with fewer residual ST changes at hospital discharge.
Methods and Results-ECGs were evaluated centrally in a core laboratory in 3122 ticagrelor- and 3084 clopidogrel-assigned patients having at least 1 mm ST-elevation in 2 contiguous leads as identified by site investigators on the qualifying ECG. Patients with greater ST-segment shift at baseline had higher rates of vascular death/myocardial infarction within 1 year. Among those who also had an ECG at hospital discharge (n = 4798), patients with >= 50% Sigma ST-deviation (Sigma ST-dev) resolution had higher event-free survival than those with incomplete resolution (6.4% versus 8.8%, adjusted hazard ratio 0.69 (0.54-0.88), P = 0.003). The extent of Sigma ST-dev resolution was similar irrespective of treatment assignment. The benefit of ticagrelor versus clopidogrel on clinical events was consistent irrespective of the extent of baseline Sigma ST-dev (P(interaction) =0.728). When stratified according to conventional times from symptom onset, ie, <= 3 hours, 3 to 6 hours, >6 hours, the extent of baseline Sigma ST-dev declined progressively over time. As time from symptom onset increased beyond 3 hours, the benefit of ticagrelor appeared to be more pronounced; however, the interaction between time and treatment was not significant (P = 0.175).
Conclusions-Ticagrelor did not modify Sigma ST-dev resolution at discharge nor was its benefit affected by the extent of baseline Sigma ST-dev. These hypothesis-generating observations suggest that the main effects of ticagrelor may not relate to the rapidity or the completeness of acute reperfusion, but rather the prevention of recurrent vascular events by more powerful platelet inhibition or other mechanisms. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT00391872. (Circulation. 2012; 125: 514-521.)
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Details
- Title
- ST-Elevation Acute Coronary Syndromes in the Platelet Inhibition and Patient Outcomes (PLATO) Trial Insights From the ECG Substudy
- Creators
- Paul W. Armstrong - University of AlbertaHany Siha - University of AlbertaYuling Fu - University of AlbertaCynthia M. Westerhout - University of AlbertaPh. Gabriel Steg - INSERM, AP HP, U 698, Paris, FranceStefan K. James - Univ Uppsala Hosp, Uppsala, SwedenRobert F. Storey - University of SheffieldJay Horrow - AstraZenecaHugo Katus - Heidelberg UniversityPeter Clemmensen - Copenhagen Univ Hosp, Copenhagen, DenmarkRobert A. Harrington - Duke Clin Res Inst, Durham, NC USALars Wallentin - Uppsala Clin Res Ctr, Uppsala, Sweden
- Publication Details
- Circulation (New York, N.Y.), v 125(3), pp 514-U131
- Publisher
- Lippincott Williams & Wilkins
- Number of pages
- 11
- Grant note
- Regado Biosciences Bristol-Myers Squibb Canada; Bristol-Myers Squibb Medicines Co Regado sanofi-aventis; Sanofi-Aventis Medtronic Eli Lilly Servier Portola Pharmaceuticals AstraZeneca Millennium Pharmaceuticals; Takeda Pharmaceutical Company Ltd Menarini; Menarini Group Endotis GlaxoSmithKline; GlaxoSmithKline Portola Pharmaceutical Inc Merck; Merck & Company Takeda Pharmaceuticals; Takeda Pharmaceutical Company Ltd Merck Sharp Dohme Corp; Merck & Company Scios Inc Teva; Teva Pharmaceutical Industries Schering-Plough; Merck & Company; Schering Plough Corporation Athera Johnson Johnson; Johnson & Johnson; Johnson & Johnson USA GlaxoSmithKline Otsuka; Otsuka Pharmaceutical Astellas; Astellas Pharmaceuticals Bayer; Bayer AG Daiichi-Sankyo; Daiichi Sankyo Company Limited Eli Lilly/Daiichi Sankyo; Daiichi Sankyo Company Limited; Eli Lilly F. Hoffman La Roche Ltd Pierre Fabre Ortho-Biotech Boehringer Ingelheim Nycomed Merck Sharpe Dohme; Merck & Company
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Anesthesiology and Perioperative Medicine
- Web of Science ID
- WOS:000300252800019
- Scopus ID
- 2-s2.0-84856441795
- Other Identifier
- 991020785742604721
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- Collaboration types
- Industry collaboration
- Domestic collaboration
- International collaboration
- Web of Science research areas
- Cardiac & Cardiovascular Systems
- Peripheral Vascular Disease