Abstract 16940: Extent of Coronary Artery Disease and Outcomes After Ticagrelor Administration: Insights from The PLATelet Inhibition and Patient Outcomes (PLATO) Trial
Background: Patients with extensive coronary artery disease (CAD) have higher risk and may derive more benefit from more potent treatment. In this substudy of the PLATO trial we studied the effects of randomized treatment dependent of extent of CAD.
Methods: Patients were classified according to whether they had extensive CAD (defined as 3-vessel disease, left main disease or prior coronary artery bypass graft surgery) or not. The trial’s primary and secondary end points were compared using Cox proportional hazards regression.
Results: Of the 15,388 study patients for whom the extent of CAD was known, 4,644 (30%) had extensive CAD. Fewer patients with extensive CAD underwent percutaneous coronary intervention (58%) compared to those without (79%, P<0.001), and more patients with extensive CAD underwent coronary artery bypass graft surgery (16% vs. 2%, P<0.001). Extensive CAD patients had more high risk characteristics at study entry and experienced more clinical events during follow-up. Ticagrelor, compared to clopidogrel, reduced the composite of cardiovascular death, myocardial infarction, and stroke in patients with extensive CAD [14.9% vs. 17.6%; hazard ratio (HR) 0.85 (0.73, 0.98)] similar to its reduction in those without extensive CAD [6.8% vs. 8.0%; HR 0.85 (0.74, 0.98), Pinteraction=0.99] (Table). Major bleeding was similar with ticagrelor vs. clopidogrel among patients without [7.3% vs. 6.4%; HR, 1.14 (0.98, 1.33)] and with [25.7% vs. 25.5%; HR, 1.02 (0.90, 1.15), Pinteraction=0.23] extensive CAD.
Conclusions: Patients with extensive CAD have high rates of recurrent cardiovascular events, death, and bleeding. However, both patients with and without extensive CAD display a reduction by ticagrelor relative to clopidogrel for ischemic events with bleeding similar to clopidogrel.
- © 2012 by American Heart Association, Inc.