title: Ticagrelor versus clopidogrel in patients with acute coronary syndromes intended for non-invasive management: substudy from prospective randomised PLATelet inhibition and patient Outcomes (PLATO) trial.
abstract: OBJECTIVE
  To evaluate efficacy and safety outcomes in patients in the PLATelet inhibition and patient Outcomes (PLATO) trial who at randomisation were planned for a non-invasive treatment strategy.
  
  
  METHODS
  Pre-specified analysis of pre-randomisation defined subgroup of prospective randomised clinical trial.
  
  
  METHODS
  862 centres in 43 countries.
  
  
  METHODS
  5216 (28%) of 18,624 patients admitted to hospital for acute coronary syndrome who were specified as planned for non-invasive management.
  
  
  METHODS
  Randomised treatment with ticagrelor (n=2601) versus clopidogrel (2615).
  
  
  METHODS
  Primary composite end point of cardiovascular death, myocardial infarction, and stroke; their individual components; and PLATO defined major bleeding during one year.
  
  
  RESULTS
  2183 (41.9%) patients had coronary angiography during their initial hospital admission, 1065 (20.4%) had percutaneous coronary intervention, and 208 (4.0%) had coronary artery bypass surgery. Cumulatively, 3143 (60.3%) patients had been managed non-invasively by the end of follow-up. The incidence of the primary end point was lower with ticagrelor than with clopidogrel (12.0% (n=295) v 14.3% (346); hazard ratio 0.85, 95% confidence interval 0.73 to 1.00; P=0.04). Overall mortality was also lower (6.1% (147) v 8.2% (195); 0.75, 0.61 to 0.93; P=0.01). The incidence of total major bleeding (11.9% (272) v 10.3% (238); 1.17, 0.98 to 1.39; P=0.08) and non-coronary artery bypass grafting related major bleeding (4.0% (90) v 3.1% (71); 1.30, 0.95 to 1.77; P=0.10) was numerically higher with ticagrelor than with clopidogrel.
  
  
  CONCLUSIONS
  In patients with acute coronary syndrome initially intended for non-invasive management, the benefits of ticagrelor over clopidogrel were consistent with those from the overall PLATO results, indicating the broad benefits of P2Y12 inhibition with ticagrelor regardless of intended management strategy.
  
  
  BACKGROUND
  Clinical trials NCT00391872.
authors.affiliation: Uppsala Clinical Research Center, Uppsala University, Sweden. Stefan.James@ucr.uu.se
authors.forename: Stefan K
authors.initials: SK
authors.lastname: James
authors.forename: Matthew T
authors.initials: MT
authors.lastname: Roe
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Cannon
authors.forename: Jan H
authors.initials: JH
authors.lastname: Cornel
authors.forename: Jay
authors.initials: J
authors.lastname: Horrow
authors.forename: Steen
authors.initials: S
authors.lastname: Husted
authors.forename: Hugo
authors.initials: H
authors.lastname: Katus
authors.forename: Joao
authors.initials: J
authors.lastname: Morais
authors.forename: Ph Gabriel
authors.initials: PG
authors.lastname: Steg
authors.forename: Robert F
authors.initials: RF
authors.lastname: Storey
authors.forename: Susanna
authors.initials: S
authors.lastname: Stevens
authors.forename: Lars
authors.initials: L
authors.lastname: Wallentin
authors.forename: Robert A
authors.initials: RA
authors.lastname: Harrington
mesh_terms: D054058:Acute Coronary Syndrome / Q000188:drug therapy*; D000241:Adenosine / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000077144:Clopidogrel; D006801:Humans; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D011446:Prospective Studies; D000077486:Ticagrelor; D013988:Ticlopidine / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D000077486:Ticagrelor; D000241:Adenosine; D013988:Ticlopidine