Ticagrelor versus clopidogrel in elderly patients with acute coronary syndromes: a substudy from the prospective randomized PLATelet inhibition and patient Outcomes (PLATO) trial.

Abstract

BACKGROUND:

Elderly patients with acute coronary syndrome are at high risk of recurrent ischemic events and death, and for both antithrombotic therapy and catheter-based complications. This prespecified analysis investigates the effect and treatment-related complications of ticagrelor versus clopidogrel in elderly patients (≥75 years of age) with acute coronary syndrome compared with those <75 years of age.

METHODS AND RESULTS:

The association between age and the primary composite outcome, as well as major bleeding were evaluated in the PLATelet inhibition and patient Outcomes (PLATO) trial using Cox proportional hazards. Similar models were used to evaluate the interaction of age with treatment effects. Hazard ratios were adjusted for baseline characteristics. The clinical benefit of ticagrelor over clopidogrel was not significantly different between patients aged ≥75 years of age (n=2878) and those <75 years of age (n=15 744) with respect to the composite of cardiovascular death, myocardial infarction, or stroke (interaction P=0.56), myocardial infarction (P=0.33), cardiovascular death (P=0.47), definite stent thrombosis (P=0.81), or all-cause mortality (P=0.76). No increase in PLATO-defined overall major bleeding with ticagrelor versus clopidogrel was observed in patients aged ≥75 years (hazard ratio, 1.02; 95% confidence interval, 0.82-1.27) or patients aged <75 years (hazard ratio, 1.04; 95% confidence interval, 0.94-1.15). Dyspnea and ventricular pauses were more common during ticagrelor than clopidogrel treatment, with no evidence of an age-by-treatment interaction.

CONCLUSIONS:

The significant clinical benefit and overall safety of ticagrelor compared with clopidogrel in acute coronary syndrome patients in the PLATO cohort were not found to depend on age.

• Authors: Steen Husted, Stefan James, Richard C Becker, Jay Horrow, Hugo Katus, Robert F Storey, Christopher P Cannon, Magda Heras, Renato D Lopes, Joao Morais, Kenneth W Mahaffey, Richard G Bach, Daniel Wojdyla, Lars Wallentin, PLATO study group
• Journal: Circulation. Cardiovascular quality and outcomes (Circ Cardiovasc Qual Outcomes) Vol. 5 Issue 5 Pg. 680-8 (Sep 01 2012) ISSN: 1941-7705 [Electronic] United States
• PMID: 22991347 (Publication Type: Comparative Study, Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Platelet Aggregation Inhibitors
• Clopidogrel
• Ticagrelor
• Adenosine
• Ticlopidine

Topics

• Acute Coronary Syndrome (blood, complications, drug therapy, mortality)
• Adenosine (adverse effects, analogs & derivatives, therapeutic use)
• Age Factors
• Aged
• Cardiovascular Diseases (etiology, mortality, prevention & control)
• Chi-Square Distribution
• Clopidogrel
• Double-Blind Method
• Female
• Hemorrhage (chemically induced)
• Humans
• Kaplan-Meier Estimate
• Male
• Patient Safety
• Percutaneous Coronary Intervention (adverse effects, instrumentation)
• Platelet Aggregation (drug effects)
• Platelet Aggregation Inhibitors (adverse effects, therapeutic use)
• Proportional Hazards Models
• Prospective Studies
• Risk Assessment
• Risk Factors
• Stents
• Ticagrelor
• Ticlopidine (adverse effects, analogs & derivatives, therapeutic use)
• Time Factors
• Treatment Outcome