Reduction in first and recurrent cardiovascular events with ticagrelor compared with clopidogrel in the PLATO Study.
Abstract | BACKGROUND: METHODS AND RESULTS: In the PLATelet inhibition and patient Outcomes (PLATO) study, 18 624 patients presenting with acute coronary syndromes randomly received ticagrelor (n=9333) or clopidogrel (n=9291). Cox proportional hazard models were used to calculate time to first event and hazard ratios. Total events were compared using a Poisson regression model, and time to second event or death was calculated with the Wei Lin Weissfeld method. Patients randomized to ticagrelor had 1057 total primary end point events versus 1225 for patients on clopidogrel (rate ratio, 0.86; 95% confidence interval, 0.79-0.93; P=0.003). The number of additional events was numerically lower for ticagrelor (189 versus 205; P=0.40), resulting in a hazard for time to second event/death of 0.80 (95% confidence interval, 0.70-0.90; P<0.001) and a number needed to treat of 54. For cardiovascular death/ myocardial infarction/ stroke/(severe) recurrent ischemia/ transient ischemic attack/arterial thrombotic events, total events were fewer with ticagrelor (2030 versus 2290; rate ratio, 0.88; 95% confidence interval, 0.82-0.95; P<0.001), with fewer recurrent events with ticagrelor (740 versus 834; P=0.01) and a highly significant concurrent reduction in hazard for time to second event or death of 0.83 (95% confidence interval, 0.75-0.91; P<0.001). Recurrent PLATO major or Thrombolysis in Myocardial Infarction (TIMI) major non- coronary artery bypass graft bleeding events were infrequent and not different between the two therapies (P=0.96 and 0.38, respectively). CONCLUSIONS: In PLATO, treatment with ticagrelor compared with clopidogrel resulted in a reduction in total events, including first and subsequent recurrent cardiovascular events, when compared with clopidogrel. These types of analyses demonstrate an even greater absolute benefit of ticagrelor over clopidogrel than previously reported. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov/. Unique identifier: NCT00391872.
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Authors | Payal Kohli, Lars Wallentin, Eric Reyes, Jay Horrow, Steen Husted, Dominick J Angiolillo, Diego Ardissino, Gerald Maurer, Joao Morais, José C Nicolau, Ali Oto, Robert F Storey, Stefan K James, Christopher P Cannon |
Journal | Circulation
(Circulation)
Vol. 127
Issue 6
Pg. 673-80
(Feb 12 2013)
ISSN: 1524-4539 [Electronic] United States |
PMID | 23277305
(Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
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Chemical References |
- Platelet Aggregation Inhibitors
- Purinergic P2Y Receptor Antagonists
- Clopidogrel
- Ticagrelor
- Adenosine
- Ticlopidine
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Topics |
- Acute Coronary Syndrome
(drug therapy, mortality)
- Adenosine
(analogs & derivatives, therapeutic use)
- Aged
- Aged, 80 and over
- Clopidogrel
- Female
- Humans
- Ischemic Attack, Transient
(drug therapy, mortality, prevention & control)
- Male
- Middle Aged
- Myocardial Infarction
(drug therapy, mortality, prevention & control)
- Platelet Aggregation Inhibitors
(therapeutic use)
- Purinergic P2Y Receptor Antagonists
(therapeutic use)
- Secondary Prevention
- Severity of Illness Index
- Stroke
(drug therapy, mortality, prevention & control)
- Thrombosis
(drug therapy, mortality, prevention & control)
- Ticagrelor
- Ticlopidine
(analogs & derivatives, therapeutic use)
- Treatment Outcome
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