Stent Thrombosis with Ticagrelor versus Clopidogrel in Patients with Acute Coronary Syndromes: An Analysis from the Prospective Randomized PLATO Trial.
Circulation. 2013 Jul 30;
Authors: Steg PG, Harrington RA, Emanuelsson H, Katus HA, Mahaffey KW, Meier B, Storey RF, Wojdyla DM, Lewis BS, Maurer G, Wallentin L, James SK, for the PLATO study group
BACKGROUND: We aimed to describe the effects of ticagrelor vs. clopidogrel on stent thrombosis in the PLATelet inhibition and patient Outcomes (PLATO) trial.
METHODS AND RESULTS: Of 18,624 patients hospitalized for ACS, 11,289 (61%) had at least one intracoronary stent. Ticagrelor reduced stent thrombosis vs. clopidogrel across all definitions: definite 1.37% (n=71) vs. 1.93% (n=105); (HR 0.67, 95% confidence interval [CI] (0.50 - 0.90), p= 0.0091) definite or probable 2.21% (n=118) vs. 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) vs. 3.77 (n=201): HR 0.77, 95% CI (0.62 - 0.95). The reduction in definite stent thrombosis was consistent regardless of ACS type, diabetes, stent type (drug-eluting or bare metal), CYP2C19 genetic status, loading dose of aspirin, dose of clopidogrel pre-randomization, and use of GpIIb/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 [24 h - 30 days: HR 0.60, 95% CI (0.39 - 0.93)] vs. acute stent thrombosis [< 24 h: HR 0.94 95% CI (0.43 - 2.05)], or for patients compliant to therapy (i.e. taking blinded study treatment ≥ 80% of the time) vs 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)].
CONCLUSIONS: Ticagrelor compared with clopidogrel reduces the incidence of stent thrombosis in ACS patients, with consistent benefit across a broad range of patient, stent and treatment characteristics.
CLINICAL TRIAL REGISTRATION INFORMATION: http://www.clinicalTrials.gov. Identifier: NCT00391872.
PMID: 23900047 [PubMed - as supplied by publisher]