Ticagrelor significantly reduced definite stent thrombosis compared with clopidogrel in patients with acute coronary syndromes (1.37% vs 1.93%; HR 0.67; 95% CI 0.50-0.90; P=0.0091).
RCT (n=11,289)
Blinded
Randomized
Yes
Does ticagrelor reduce stent thrombosis compared with clopidogrel in patients with acute coronary syndromes and intracoronary stents?
Ticagrelor significantly reduces the incidence of stent thrombosis compared to clopidogrel in patients with acute coronary syndromes undergoing stenting.
Hazard Ratio: 0.67 (95% CI 0.5–0.9)
Absolute Event Rate: 1.37% vs 1.93%
p-value: p=0.0091
BACKGROUND: We aimed to describe the effects of ticagrelor versus clopidogrel on stent thrombosis in the Platelet Inhibition and Patient Outcomes (PLATO) trial. METHODS AND RESULTS: Of 18 624 patients hospitalized for acute coronary syndromes, 11 289 (61%) had at least 1 intracoronary stent. Ticagrelor reduced stent thrombosis compared with clopidogrel across all definitions: definite, 1.37% (n=71) versus 1.93% (n=105; hazard ratio HR, 0.67; 95% confidence interval CI, 0.50-0.90; P=0.0091); definite or probable, 2.21% (n=118) versus 2.87% (n=157; HR, 0.75; 95% CI, 0.59-0.95; P=0.017); and definite, probable, and possible, 2.94% (n=154) versus 3.77 (n=201; HR, 0.77; 95% CI, 0.62-0.95). The reduction in definite stent thrombosis was consistent regardless of acute coronary syndrome type, presence of diabetes mellitus, stent type (drug-eluting or bare metal stent), CYP2C19 genetic status, loading dose of aspirin, dose of clopidogrel before randomization, and use of glycoprotein IIb/IIIa inhibitors at randomization. The reduction in stent thrombosis with ticagrelor was numerically greater for late (>30 days; HR, 0.48; 95% CI, 0.24-0.96) and subacute (4 hours-30 days; HR, 0.60; 95% CI, 0.39-0.93) compared with acute (<24 hours; HR, 0.94; 95% CI, 0.43-2.05) stent thrombosis or for patients compliant to therapy (ie, taking blinded study treatment ≥80% of the time) compared with less compliant patients. Randomization to ticagrelor was a strong independent inverse predictor of definite stent thrombosis (HR, 0.65; 95% CI, 0.48-0.88). CONCLUSION: Ticagrelor compared with clopidogrel reduces the incidence of stent thrombosis in patients with acute coronary syndromes, with consistent benefit across a broad range of patient, stent, and treatment characteristics.
Steg et al. (Wed,) conducted a rct in Acute coronary syndromes with intracoronary stent (n=11,289). Ticagrelor vs. Clopidogrel was evaluated on Definite stent thrombosis (HR 0.67, 95% CI 0.50-0.90, p=0.0091). Ticagrelor significantly reduced definite stent thrombosis compared with clopidogrel in patients with acute coronary syndromes (1.37% vs 1.93%; HR 0.67; 95% CI 0.50-0.90; P=0.0091).