Abstract 15029: Ticagrelor Versus Clopidogrel in Patients with Acute Coronary Syndromes and History of Stroke or Transient Ischemic Accident: Results from the Platelet Inhibition and Patient Outcomes Trial
Background: Despite current therapy, patients with acute coronary syndrome (ACS) and history of stroke or transient ischemic attack (TIA) have both a high risk of recurrent cardiac events and bleeding including intracranial hemorrhage. In the PLATelet inhibition and patient Outcomes (PLATO) trial, ticagrelor (T) reduced ischemic events and mortality compared with clopidogrel (C).
Methods: The statistical analyses performed on the full PLATO cohort was repeated for those patients with a history of prior stroke or TIA.Results of this exploratory analysis appear with nominal significance levels not corrected for multiplicity.
Results: Of 18,624 ACS patients in PLATO, 1,152 (6%) had history of stroke or TIA at randomization. These patients were older (mean 67 vs. 62 yr) and had numerically higher comorbidities than the overall population: diabetes 35 vs. 25%; heart failure 11 vs. 6%; prior myocardial infarction 30 vs. 20%; chronic renal disease 6 vs. 4%. Bleeding rates in this subgroup were considerably higher and ischemic event rates were twice as high. The reduction of the primary composite outcome (vascular death, myocardial infarction and stroke), cardiovascular and total mortality at one year with ticagrelor vs. clopidogrel was consistent with the overall trial result. There was no difference in stroke, including hemorrhagic stroke. The rate of overall PLATO-defined and non-coronary artery bypass graft related major bleedings were similar as was the number of intracranial bleedings.
Conclusions: PLATO patients with prior ischemic stroke or TIA had high event rates but exhibited efficacy and bleeding results similar to those results in the overall trial population; if otherwise indicated, T should not be withheld from these patients.
- © 2011 by American Heart Association, Inc.