Extent of coronary artery disease and outcomes after ticagrelor administration in patients with an acute coronary syndrome: Insights from the PLATelet inhibition and patient Outcomes (PLATO) trial

Anna Kotsia, Emmanouil Brilakis, Claes Held, Christopher Cannon, Gabriel Steg, Bernhard Meier, Frank Cools, Marc Claeys, Jan Cornel, Philip Aylward, Basil Lewis, Douglas Weaver, Gunnar Brandrup-Wognsen, Susanna Stevens, Anders Himmelmann, Lars Wallentin, Stefan James

    Research output: Contribution to journalArticle

    6 Citations (Scopus)

    Abstract

    Background Extensive coronary artery disease (CAD) is associated with higher risk. In this substudy of the PLATO trial, we examined the effects of randomized treatment on outcome events and safety in relation to the extent of CAD. Methods Patients were classified according to presence of extensive CAD (defined as 3-vessel disease, left main disease, or prior coronary artery bypass graft surgery). The trial's primary and secondary end points were compared using Cox proportional hazards regression. Results Among 15,388 study patients for whom the extent of CAD was known, 4,646 (30%) had extensive CAD. Patients with extensive CAD had more high-risk characteristics and experienced more clinical events during follow-up. They were less likely to undergo percutaneous coronary intervention (58% vs 79%, P <.001) but more likely to undergo coronary artery bypass graft surgery (16% vs 2%, P <.001). Ticagrelor, compared with clopidogrel, reduced the composite of cardiovascular death, myocardial infarction, and stroke in patients with extensive CAD (14.9% vs 17.6%, hazard ratio [HR] 0.85 [0.73-0.98]) similar to its reduction in those without extensive CAD (6.8% vs 8.0%, HR 0.85 [0.74-0.98], P interaction =.99). Major bleeding was similar with ticagrelor vs clopidogrel among patients with (25.7% vs 25.5%, HR 1.02 [0.90-1.15]) and without (7.3% vs 6.4%, HR 1.14 [0.98-1.33], Pinteraction =.24) extensive CAD. Conclusions Patients with extensive CAD have higher rates of recurrent cardiovascular events and bleeding. Ticagrelor reduced ischemic events to a similar extent both in patients with and without extensive CAD, with bleeding rates similar to clopidogrel.

    Original languageEnglish
    Pages (from-to)68.e2-75.e2
    Number of pages8
    JournalAmerican Heart Journal
    Volume168
    Issue number1
    DOIs
    Publication statusPublished - 2014

    Fingerprint Dive into the research topics of 'Extent of coronary artery disease and outcomes after ticagrelor administration in patients with an acute coronary syndrome: Insights from the PLATelet inhibition and patient Outcomes (PLATO) trial'. Together they form a unique fingerprint.

  • Cite this

    Kotsia, A., Brilakis, E., Held, C., Cannon, C., Steg, G., Meier, B., Cools, F., Claeys, M., Cornel, J., Aylward, P., Lewis, B., Weaver, D., Brandrup-Wognsen, G., Stevens, S., Himmelmann, A., Wallentin, L., & James, S. (2014). Extent of coronary artery disease and outcomes after ticagrelor administration in patients with an acute coronary syndrome: Insights from the PLATelet inhibition and patient Outcomes (PLATO) trial. American Heart Journal, 168(1), 68.e2-75.e2. https://doi.org/10.1016/j.ahj.2014.04.001