TY - JOUR
T1 - Ticagrelor versus clopidogrel in Asian patients with acute coronary syndrome
T2 - A retrospective analysis from the Platelet Inhibition and Patient Outcomes (PLATO) Trial
AU - Kang, Hyun Jae
AU - Clare, Robert M.
AU - Gao, Runlin
AU - Held, Claes
AU - Himmelmann, Anders
AU - James, Stefan K.
AU - Lim, Soo Teik
AU - Santoso, Anwar
AU - Yu, Cheuk Man
AU - Wallentin, Lars
AU - Becker, Richard C.
N1 - Funding Information:
H.J.K., R.M.C., R.G., C.M.Y.: nothing to disclose. C.H.: reports institutional research grants from AstraZeneca, Merck, GlaxoSmithKline, Roche, and Bristol-Myers Squibb/Pfizer; honoraria from and advisory board member for AstraZeneca. A.H.: employed by, and has stock and stock options in, AstraZeneca, the PLATO trial sponsor; author does not consider that this creates any conflict of interest with the subject matter of this manuscript. S.K.J.: receives institutional research grant from AstraZeneca, Eli Lilly, Bristol-Myers Squibb, Terumo Inc, Medtronic, and Vascular Solutions; honoraria from The Medicines Company, AstraZeneca, Eli Lilly, Bristol-Myers Squibb, and IROKO; and consultant/advisory board fees from AstraZeneca, Eli Lilly, Merck, Medtronic, and Sanofi. S.T.L.: advisory board member of Astra Zeneca, Boehringer Ingelheim; honoraria from Medtronic, Biosensors, Biotronik; travel support from Boston Scientific, Abbott Vascular, Biosensors, Medtronic, Asahi Intecc, Orbus- Neich, Astra Zeneca, Actelion. A.S.: an advisory board member for AstraZeneca, Merck. L.W.: research grants from AstraZeneca, Merck & Co, Boehringer Ingelheim, Bristol-Myers Squibb/Pfizer, GlaxoSmithKline; consultant for Abbott, Merck & Co, Regado Biosciences, Athera Biotechnologies, Boehringer Ingelheim, AstraZeneca, GlaxoSmithKline, and Bristol-Myers Squibb/Pfizer; lecture fees from AstraZeneca, Boehringer Ingelheim, Bristol-Myers Squibb/Pfizer, GlaxoSmithKline; honoraria from Boehringer Ingelheim, AstraZeneca, Bristol-Myers Squibb/Pfizer, GlaxoSmithKline; travel support from AstraZeneca, Bristol-Myers Squibb/Pfizer, and GlaxoSmithKline. R.C.B.: grants from AstraZeneca; scientific advisory board member for Bayer, Janssen, and Regado Biosciences; and safety reviewing committee member for Portola.
Publisher Copyright:
© 2015 The Authors.
PY - 2015/6/1
Y1 - 2015/6/1
N2 - Background In the PLATO trial, ticagrelor was superior to clopidogrel in reducing cardiovascular events among patients with acute coronary syndrome (ACS) at the expense of increased nonfatal bleeding. Because Asian patients, when compared with non-Asian patients, are believed to be more susceptible to bleeding, we evaluated the effects of ticagrelor compared with clopidogrel in Asian (n = 1,106) and non-Asian (n = 17,515) patients with acute coronary syndrome enrolled in the PLATO study. Methods and Results Interaction between Asian/non-Asian and primary efficacy end point (a composite of vascular death, myocardial infarction, and stroke) and net clinical benefit (composite of primary efficacy end point and coronary artery bypass graft [CABG] surgery or non-CABG-related major bleeding) were evaluated with a Cox proportional hazards model. Baseline demographics and comorbidities were different between Asians and non-Asians. The overall cardiovascular event rates were higher in Asians, but bleeding rates were similar. Despite these observed differences, the effects of ticagrelor versus clopidogrel were not significantly different between Asians and non-Asians with respect to the primary efficacy outcome (hazard ratio for Asians vs non-Asians, 0.84 [95% CI 0.61-1.17] vs 0.85 [95% CI 0.77-0.93], P =.974), net clinical benefit (0.85 [95% CI 0.65-1.11] vs 0.93 [95% CI 0.86-0.99], P =.521), or individual efficacy end points. There was no significant interaction for bleeding (PLATO major bleeding, 1.02 [95% CI 0.70-1.49] vs 1.04 [95% CI 0.95-1.14], P =.938) and other related adverse events with ticagrelor compared with clopidogrel between Asians and non-Asians. Conclusions We observed consistency of effects in Asian patients receiving ticagrelor and clopidogrel in the PLATO study. The relatively modest number of Asian patients in this analysis supports further investigation of larger cohorts to confirm our observations.
AB - Background In the PLATO trial, ticagrelor was superior to clopidogrel in reducing cardiovascular events among patients with acute coronary syndrome (ACS) at the expense of increased nonfatal bleeding. Because Asian patients, when compared with non-Asian patients, are believed to be more susceptible to bleeding, we evaluated the effects of ticagrelor compared with clopidogrel in Asian (n = 1,106) and non-Asian (n = 17,515) patients with acute coronary syndrome enrolled in the PLATO study. Methods and Results Interaction between Asian/non-Asian and primary efficacy end point (a composite of vascular death, myocardial infarction, and stroke) and net clinical benefit (composite of primary efficacy end point and coronary artery bypass graft [CABG] surgery or non-CABG-related major bleeding) were evaluated with a Cox proportional hazards model. Baseline demographics and comorbidities were different between Asians and non-Asians. The overall cardiovascular event rates were higher in Asians, but bleeding rates were similar. Despite these observed differences, the effects of ticagrelor versus clopidogrel were not significantly different between Asians and non-Asians with respect to the primary efficacy outcome (hazard ratio for Asians vs non-Asians, 0.84 [95% CI 0.61-1.17] vs 0.85 [95% CI 0.77-0.93], P =.974), net clinical benefit (0.85 [95% CI 0.65-1.11] vs 0.93 [95% CI 0.86-0.99], P =.521), or individual efficacy end points. There was no significant interaction for bleeding (PLATO major bleeding, 1.02 [95% CI 0.70-1.49] vs 1.04 [95% CI 0.95-1.14], P =.938) and other related adverse events with ticagrelor compared with clopidogrel between Asians and non-Asians. Conclusions We observed consistency of effects in Asian patients receiving ticagrelor and clopidogrel in the PLATO study. The relatively modest number of Asian patients in this analysis supports further investigation of larger cohorts to confirm our observations.
UR - http://www.scopus.com/inward/record.url?scp=84930183164&partnerID=8YFLogxK
U2 - 10.1016/j.ahj.2015.03.015
DO - 10.1016/j.ahj.2015.03.015
M3 - Article
C2 - 26027629
AN - SCOPUS:84930183164
VL - 169
SP - 899-905.e1
JO - American Heart Journal
JF - American Heart Journal
SN - 0002-8703
IS - 6
ER -