Abstract 17001: Net Clinical Benefits of Ticagrelor Compared With Clopidogrel in Asian Acute Coronary Syndrome Patients: A Plato Sub-Study
Background: In the PLATO study, ticagrelor was superior to clopidogrel in reducing cardiovascular events among patients with acute coronary syndrome (ACS). Because Asian patients, when compared with non-Asian patients, differ in body stature, genetic background, comorbid disease and management strategies, and are believed to be more susceptible to bleeding, we evaluated the net clinical benefit of ticagrelor compared with clopidogrel in Asian (n=1106) and non-Asian (n=17515) ACS patient enrolled in PLATO.
Methods and Results: Primary composite outcome (cardiovascular [CV] death, myocardial infarction [MI], and stroke), individual CV outcomes, major bleeding, and net clinical benefit (composite of primary composite outcome and non-CABG major or any fatal bleeding) were evaluated. Heterogeneity was analyzed with a Cox proportional hazards model. At baseline Asian patients had lower body weight, and a higher proportion of subjects with diabetes mellitus, prior non-hemorrhagic stroke, and ST segment elevation MI as an index event compared with non-Asian patients. And the proportion of subjects with concomitant cardiac medications was lower in Asian patients. The overall CV event rates were higher in Asian patients, however bleeding rates were similar. Despite these observed differences, the effects and safety of ticagrelor over clopidogrel were not significantly different between Asian and non-Asian with respect to net clinical benefit, primary composite outcome, all cause death, CV death, MI or CV death, stroke, PLATO and non-CABG major bleedings (p for interaction>0.05: see figure).
Conclusion: Although there were differences in patient demographics, comorbid disease and treatment patterns between Asian and non-Asian patients participating in PLATO, we observed consistent effects of ticagrelor compared with clopidogrel on reduction in CV events, overall safety, and net clinical benefit in Asian ACS patients.
- © 2013 by American Heart Association, Inc.