Ticagrelor Versus Clopidogrel in Patients With Acute Coronary Syndromes and Chronic Obstructive Pulmonary Disease: An Analysis From the Platelet Inhibition and Patient Outcomes (PLATO) Trial.

Autor: Andell P; Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden (P.A., S.K., D.E.)., James SK; Department of Medical Sciences, Cardiology and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden (S.K.J., L.W.)., Cannon CP; Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (C.P.C.) Harvard Clinical Research Institute, Boston, MA (C.P.C.)., Cyr DD; Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (D.D.C.)., Himmelmann A; AstraZeneca Research and Development, Mölndal, Sweden (A.H.)., Husted S; Medical Department, Hospital Unit West, Herning/Holstebro, Denmark (S.H.)., Keltai M; Hungarian Institute of Cardiology, Semmelweis University, Budapest, Hungary (M.K.)., Koul S; Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden (P.A., S.K., D.E.)., Santoso A; Department of Cardiology, Vascular Medicine, Faculty of Medicine, Harapan Kita Hospital, National Cardiovascular Center, University of Indonesia, Jakarta, Indonesia (A.S.)., Steg PG; INSERM-Unité 1148, Paris, France (P.G.S.) Département Hospitalo-Universitaire FIRE, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, Paris, France (P.G.S.) Sorbonne-Paris Cité, Université Paris-Diderot, Paris, France (P.G.S.) NHLI Imperial College, ICMS, Royal Brompton Hospital, London, UK (P.G.S.)., Storey RF; Department of Cardiovascular Science, University of Sheffield Sheffield, UK (R.F.S.)., Wallentin L; Department of Medical Sciences, Cardiology and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden (S.K.J., L.W.)., Erlinge D; Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden (P.A., S.K., D.E.).
Jazyk: angličtina
Zdroj: Journal of the American Heart Association [J Am Heart Assoc] 2015 Oct 09; Vol. 4 (10), pp. e002490. Date of Electronic Publication: 2015 Oct 09.
DOI: 10.1161/JAHA.115.002490
Abstrakt: Background: Patients with chronic obstructive pulmonary disease (COPD) experiencing acute coronary syndromes (ACS) are at high risk for clinical events. In the Platelet Inhibition and Patient Outcomes (PLATO) trial, ticagrelor versus clopidogrel reduced the primary endpoint of death from vascular causes, myocardial infarction, or stroke after ACS, but increased the incidence of dyspnea, which may lead clinicians to withhold ticagrelor from COPD patients.
Methods and Results: In 18 624 patients with ACS randomized to treatment with ticagrelor or clopidogrel, history of COPD was recorded in 1085 (5.8%). At 1 year, the primary endpoint occurred in 17.7% of patients with COPD versus 10.4% in those without COPD (P<0.001). The 1-year event rate for the primary endpoint in COPD patients treated with ticagrelor versus clopidogrel was 14.8% versus 20.6% (hazard ratio [HR]=0.72; 95% confidence interval [CI]: 0.54 to 0.97), for death from any cause 8.4% versus 12.4% (HR=0.70; 95% CI: 0.47 to 1.04), and for PLATO-defined major bleeding rates at 1 year 14.6% versus 16.6% (HR=0.85; 95% CI: 0.61 to 1.17). Dyspnea occurred more frequently with ticagrelor (26.1% vs. 16.3%; HR=1.71; 95% CI: 1.28 to 2.30). There was no differential increase in the relative risk of dyspnea compared to non-COPD patients (HR=1.85). No COPD status-by-treatment interactions were found, showing consistency with the main trial results.
Conclusions: In this post-hoc analysis, COPD patients experienced high rates of ischemic events. Ticagrelor versus clopidogrel reduced and substantially decreased the absolute risk of ischemic events (5.8%) in COPD patients, without increasing overall major bleeding events. The benefit-risk profile supports the use of ticagrelor in patients with ACS and concomitant COPD.
Clinical Trial Registration: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00391872.
(© 2015 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.)
Databáze: MEDLINE
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