Abstract | BACKGROUND: We evaluated whether electrocardiogram (ECG) characteristics were aligned with clinical outcomes and the effect of ticagrelor within the diverse spectrum of non-ST-elevation acute coronary syndrome patients enrolled in the PLATelet inhibition and patient Outcomes (PLATO) trial. METHODS: There were 8884 PLATO patients who had baseline ECGs assessed by a core laboratory; of these, 4935 had an ECG at hospital discharge that also was assessed. Associations with study treatment on vascular death or myocardial infarction within 1 year were examined. RESULTS: At baseline, most patients had either no or ≤0.5 mm of ST-segment depression (57%); 26% had 1.0 mm, and 17% had more extensive depression (>1.0 mm). Across the baseline ST-segment depression strata, there was a consistent treatment benefit with ticagrelor versus clopidogrel on vascular death/ myocardial infarction. The extent of residual ST-segment depression at discharge was similar in the treatment groups, and the treatment effect did not differ by the extent of discharge ST-segment depression. There was a progressive increase in vascular death/ myocardial infarction with increasing extent of baseline ST-segment depression (1.0 mm [vs no/0.5 mm]: hazard ratio [HR] 1.22; 95% confidence interval [CI], 1.03-1.45; >1.0 mm: HR 1.49; 95% CI, 1.24-1.78; P <.001) and at discharge (HR 1.28; 95% CI, 1.02-1.61; HR 2.13; 95% CI, 1.54-2.95; P <.001). CONCLUSION: The treatment effect of ticagrelor among non-ST-segment-elevation acute coronary syndrome patients was consistently expressed across all baseline ST-segment depression strata. There was no indication of an anti-ischemic benefit of ticagrelor as reflected on the discharge ECG. Our data affirm the independent prognostic relationship of both baseline and hospital discharge ST-segment depression on outcomes within 1 year in non-ST-segment-elevation acute coronary syndrome patients.
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Authors | Paul W Armstrong, Cynthia M Westerhout, Yuling Fu, Robert A Harrington, Robert F Storey, Hugo Katus, Stefan James, Lars Wallentin |
Journal | The American journal of medicine
(Am J Med)
Vol. 126
Issue 8
Pg. 723-729.e1
(Aug 2013)
ISSN: 1555-7162 [Electronic] United States |
PMID | 23795897
(Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
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Copyright | Copyright © 2013 Elsevier Inc. All rights reserved. |
Chemical References |
- Purinergic P2Y Receptor Antagonists
- Clopidogrel
- Ticagrelor
- Adenosine
- Ticlopidine
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Topics |
- Acute Coronary Syndrome
(drug therapy, physiopathology)
- Adenosine
(analogs & derivatives, therapeutic use)
- Aged
- Cardiovascular Diseases
(mortality)
- Clopidogrel
- Cohort Studies
- Electrocardiography
- Female
- Humans
- Kaplan-Meier Estimate
- Male
- Middle Aged
- Myocardial Infarction
(prevention & control)
- Prognosis
- Purinergic P2Y Receptor Antagonists
(therapeutic use)
- Ticagrelor
- Ticlopidine
(analogs & derivatives, therapeutic use)
- Time Factors
- Treatment Outcome
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