Abstract | CONTEXT: OBJECTIVE: RESULTS: The FDA Complete Response Review (CRR) indicates that when MIs were broken down by index event type, ticagrelor fared better than clopidogrel only in patients with STEMI (136/3496 [4.2%] vs. 184/3530 [5.7%], hazard ratio (HR) 0.74 [0.59-0.93]), whereas patients with NSTEMI and UA showed no significant difference (288/4005 [7.9%] vs. 324/950 [8.9%], HR 0.87 [0.74-1.02] and 76/1549 [5.2%] vs. 75/1563 [5.1%], HR 1.02 [0.75-1.42]). Moreover, STEMI patients receiving early (<24 h) percutaneous coronary intervention (PCI) showed an increase in 30 day MI or cardiovascular (CV) death on ticagrelor compared to clopidogrel, in both the United States (US) and outside-US (OUS) regions (5.0% vs. 1.8% and 3.2% vs. 2.9%, respectively). CONCLUSIONS:
Ticagrelor significantly reduced MIs compared to clopidogrel only in STEMI patients, with those receiving early PCI having worse outcomes with ticagrelor. Despite, NSTEMI patients showing no significant reduction in MI with ticagrelor vs. clopidogrel, CV mortality was significantly reduced. In summary, we cannot be sure what is driving the STEMI-MI benefit, the NSTEMI-CV mortality benefit, nor the overall mortality benefit for ticagrelor-treated patients compared to clopidogrel treated patients.
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Authors | James J DiNicolantonio, Victor L Serebruany |
Journal | International journal of cardiology
(Int J Cardiol)
Vol. 165
Issue 3
Pg. 396-7
(May 25 2013)
ISSN: 1874-1754 [Electronic] Netherlands |
PMID | 23273339
(Publication Type: Comparative Study, Editorial)
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Copyright | Copyright © 2012 Elsevier Ireland Ltd. All rights reserved. |
Chemical References |
- Platelet Aggregation Inhibitors
- Purinergic P2Y Receptor Antagonists
- Clopidogrel
- Ticagrelor
- Adenosine
- Ticlopidine
|
Topics |
- Adenosine
(analogs & derivatives, therapeutic use)
- Clopidogrel
- Humans
- Myocardial Infarction
(drug therapy, epidemiology)
- Platelet Aggregation Inhibitors
(therapeutic use)
- Purinergic P2Y Receptor Antagonists
(therapeutic use)
- Randomized Controlled Trials as Topic
(methods)
- Ticagrelor
- Ticlopidine
(analogs & derivatives, therapeutic use)
- Treatment Outcome
|