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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

Andell, Pontus LU ; James, Stefan K.; Cannon, Christopher P.; Cyr, Derek D.; Himmelmann, Anders; Husted, Steen; Keltai, Matyas; Koul, Sasha LU ; Santoso, Anwar and Steg, Ph Gabriel, et al. (2015) In Journal of the American Heart Association 4(10). p.1-25
Abstract

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... (More)

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.

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published
subject
keywords
Cardiovascular diseases, Lung, Myocardial infarction
in
Journal of the American Heart Association
volume
4
issue
10
pages
25 pages
publisher
Wiley-Blackwell
external identifiers
  • pmid:26452988
  • wos:000364153000041
  • scopus:85006230938
ISSN
2047-9980
DOI
10.1161/JAHA.115.002490
language
English
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yes
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8f975ae4-5534-4d01-8cc4-493ac57c9d27 (old id 8155545)
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http://www.ncbi.nlm.nih.gov/pubmed/26452988?dopt=Abstract
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2015-11-03 11:18:38
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2017-11-12 03:37:50
@article{8f975ae4-5534-4d01-8cc4-493ac57c9d27,
  abstract     = {<p>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&lt;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.</p>},
  articleno    = {e002490},
  author       = {Andell, Pontus and James, Stefan K. and Cannon, Christopher P. and Cyr, Derek D. and Himmelmann, Anders and Husted, Steen and Keltai, Matyas and Koul, Sasha and Santoso, Anwar and Steg, Ph Gabriel and Storey, Robert F. and Wallentin, Lars and Erlinge, David},
  issn         = {2047-9980},
  keyword      = {Cardiovascular diseases,Lung,Myocardial infarction},
  language     = {eng},
  number       = {10},
  pages        = {1--25},
  publisher    = {Wiley-Blackwell},
  series       = {Journal of the American Heart Association},
  title        = {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},
  url          = {http://dx.doi.org/10.1161/JAHA.115.002490},
  volume       = {4},
  year         = {2015},
}