Abstract 14299: Cardiovascular Events in Acute Coronary Syndrome Patients With Peripheral Arterial Disease Treated With Ticagrelor Compared to Clopidogrel: Data From the PLATO Trial
Background: Patients with peripheral artery disease (PAD) and acute coronary syndrome (ACS) are at high risk for clinical events and are often difficult to manage. We evaluated cardiovascular outcomes of ACS patients with PAD treated with ticagrelor compared with clopidogrel in the PLATO Trial.
Methods: The PLATO trial was a multicenter, double-blind, randomized trial, comparing ticagrelor (180-mg loading dose, 90 mg twice daily thereafter) and clopidogrel (300-to-600-mg loading dose, 75 mg daily thereafter) for the prevention of cardiovascular events in 18,624 patients admitted with ACS. A post hoc analysis of patients with PAD (n=1144) at baseline compared to those without PAD (n=17,469) was performed for clinical characteristics and outcomes with ticagrelor and clopidogrel at 12 months.
Results: PAD patients were older (66 vs. 62 years, p<0.001), more often male (74.9 vs. 71.9%, p=0.010), and more likely to have diabetes (37.7 vs. 24.2%, p<0.001) compared with patients without PAD. The primary endpoint of death from vascular causes (CV death), myocardial infarction (MI), or stroke occurred in 19.8%/yr of patients with PAD compared to 10.2%/yr in patients without PAD, p<0.001. In PAD patients treated with ticagrelor, CV death, MI, or stroke occurred in 18%/yr vs. 20.6%/yr of patients treated with clopidogrel, p=0.22(Table). CV death or MI occurred in 16.7%/yr vs. 21.5%/yr in PAD patients treated with ticagrelor compared with patients randomized to clopidogrel, p=0.045. TIMI major bleeding occurred in 9.1%/yr of PAD patients treated with ticagrelor compared to 11.4%/yr in patients treated with clopidogrel, p=0.244.
Conclusion: Patients with ACS and PAD have a high rate of death from vascular causes, MI, or stroke. Consistent with the overall trial, ticagrelor use compared to clopidogrel in the PAD patients resulted in similar reductions in clinical events without an increase in major bleeding
- © 2011 by American Heart Association, Inc.