Abstract 15929: Outcomes with Ticagrelor Versus Clopidogrel in Relation to High Sensitivity Troponin-T in Non-ST-Elevation Acute Coronary Syndrome Patients Managed with Early Invasive or Non-Invasive Treatment - A Substudy from the Prospective Randomized PLATelet Inhibition and Patient Outcomes (PLATO) Trial
Introduction In the PLATO trial, ticagrelor versus clopidogrel reduced cardiovascular (CV) death, myocardial infarction (MI) and stroke in patients with acute coronary syndrome (ACS). We investigated outcomes in patients with non-ST-elevation (NSTE)-ACS managed with or without in-hospital revascularization in relation to high-sensitivity troponin-T (hs-TnT) level at entry.
Methods NSTE-ACS was evidenced by 2 of 3 criteria 1/ST-segment depression or 2/positive biomarker or 3/ one additional clinical risk indicator. In-hospital invasive procedures were at the discretion of the physician. Follow-up was 6 - 12 months. Hs-TnT was measured in frozen samples obtained at randomization. Treatment effects were evaluated with Cox proportional hazards model with adjustment for baseline characteristics.
Results (see figure) There were 5357 patients managed with and 4589 without revascularization during index hospitalization and with available hs-TnT. In the 5011 invasive patients with elevated hs-TnT, ticagrelor reduced the composite of CV-death, MI and stroke from 11.2% to 8.5% based on a reduction of CV-death, spontaneous MI and procedure-related MI. In the 3576 non-invasive patients with elevated hs-TnT, ticagrelor reduced the composite of CV-death, MI and stroke from 14.9% to 12.4%, mainly driven by a reduction in CV-mortality. The event rates were very low in the 1013 non-invasive NSTE-ACS patients with normal hs-TnT. Both invasive and non-invasive managed cohorts had no significant interaction of treatment with hs-TnT status.
Conclusions In patients with NSTE-ACS and elevated hs-TnT, ticagrelor improves survival, reduces CV-death and spontaneous and procedure related MI in invasively managed and reduces the composite of CV-death and spontaneous MI in non-invasively managed patients. The results emphasize that ticagrelor has its largest effect in ACS patients with elevated troponin regardless of invasive or non-invasive management.
- © 2012 by American Heart Association, Inc.