Factors contributing to the lower mortality with ticagrelor compared with clopidogrel in patients undergoing coronary artery bypass surgery.

Abstract

OBJECTIVES:

This study investigated the differences in specific causes of post-coronary artery bypass graft surgery (CABG) deaths in the PLATO (Platelet Inhibition and Patient Outcomes) trial.

BACKGROUND:

In the PLATO trial, patients assigned to ticagrelor compared with clopidogrel and who underwent CABG had significantly lower total and cardiovascular mortality.

METHODS:

In the 1,261 patients with CABG performed within 7 days after stopping study drug, reviewers blinded to treatment assignment classified causes of death into subcategories of vascular and nonvascular, and specifically identified bleeding or infection events that either caused or subsequently contributed to death.

RESULTS:

Numerically more vascular deaths occurred in the clopidogrel versus the ticagrelor group related to myocardial infarction (14 vs. 10), heart failure (9 vs. 6), arrhythmia or sudden death (9 vs. 3), and bleeding, including hemorrhagic stroke (7 vs. 2). Clopidogrel was also associated with an excess of nonvascular deaths related to infection (8 vs. 2). Among factors directly causing or contributing to death, bleeding and infections were more common in the clopidogrel group compared with the ticagrelor group (infections: 16 vs. 6, p < 0.05, and bleeding: 27 vs. 9, p < 0.01, for clopidogrel and ticagrelor, respectively).

CONCLUSIONS:

The mortality reduction with ticagrelor versus clopidogrel following CABG in the PLATO trial was associated with fewer deaths from cardiovascular, bleeding, and infection complications. (Platelet Inhibition and Patient Outcomes [PLATO]; NCT00391872).

• Authors: Christoph Varenhorst, Ulrica Alström, Benjamin M Scirica, Charles W Hogue, Nils Åsenblad, Robert F Storey, Ph Gabriel Steg, Jay Horrow, Kenneth W Mahaffey, Richard C Becker, Stefan James, Christopher P Cannon, Gunnar Brandrup-Wognsen, Lars Wallentin, Claes Held
• Journal: Journal of the American College of Cardiology (J Am Coll Cardiol) Vol. 60 Issue 17 Pg. 1623-30 (Oct 23 2012) ISSN: 1558-3597 [Electronic] United States
• PMID: 23021325 (Publication Type: Comparative Study, Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2012 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Chemical References

• Platelet Aggregation Inhibitors
• Purinergic P2Y Receptor Antagonists
• Clopidogrel
• Ticagrelor
• Adenosine
• Ticlopidine

Topics

• Acute Coronary Syndrome (drug therapy, mortality, surgery)
• Adenosine (administration & dosage, analogs & derivatives, therapeutic use)
• Clopidogrel
• Coronary Artery Bypass (mortality)
• Dose-Response Relationship, Drug
• Double-Blind Method
• Electrocardiography
• Europe (epidemiology)
• Female
• Follow-Up Studies
• Humans
• Male
• Middle Aged
• Platelet Aggregation Inhibitors (administration & dosage, therapeutic use)
• Prospective Studies
• Purinergic P2Y Receptor Antagonists (administration & dosage, therapeutic use)
• Survival Rate (trends)
• Ticagrelor
• Ticlopidine (administration & dosage, analogs & derivatives, therapeutic use)
• Treatment Outcome