title: Factors contributing to the lower mortality with ticagrelor compared with clopidogrel in patients undergoing coronary artery bypass surgery.
abstract: OBJECTIVE
  This study investigated the differences in specific causes of post-coronary artery bypass graft surgery (CABG) deaths in the PLATO (Platelet Inhibition and Patient Outcomes) trial.
  
  
  BACKGROUND
  In the PLATO trial, patients assigned to ticagrelor compared with clopidogrel and who underwent CABG had significantly lower total and cardiovascular mortality.
  
  
  METHODS
  In the 1,261 patients with CABG performed within 7 days after stopping study drug, reviewers blinded to treatment assignment classified causes of death into subcategories of vascular and nonvascular, and specifically identified bleeding or infection events that either caused or subsequently contributed to death.
  
  
  RESULTS
  Numerically more vascular deaths occurred in the clopidogrel versus the ticagrelor group related to myocardial infarction (14 vs. 10), heart failure (9 vs. 6), arrhythmia or sudden death (9 vs. 3), and bleeding, including hemorrhagic stroke (7 vs. 2). Clopidogrel was also associated with an excess of nonvascular deaths related to infection (8 vs. 2). Among factors directly causing or contributing to death, bleeding and infections were more common in the clopidogrel group compared with the ticagrelor group (infections: 16 vs. 6, p < 0.05, and bleeding: 27 vs. 9, p < 0.01, for clopidogrel and ticagrelor, respectively).
  
  
  CONCLUSIONS
  The mortality reduction with ticagrelor versus clopidogrel following CABG in the PLATO trial was associated with fewer deaths from cardiovascular, bleeding, and infection complications. (Platelet Inhibition and Patient Outcomes [PLATO]; NCT00391872).
authors.affiliation: Uppsala Clinical Research Center and Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden. christoph.varenhorst@ucr.uu.se
authors.forename: Christoph
authors.initials: C
authors.lastname: Varenhorst
authors.forename: Ulrica
authors.initials: U
authors.lastname: Alström
authors.forename: Benjamin M
authors.initials: BM
authors.lastname: Scirica
authors.forename: Charles W
authors.initials: CW
authors.lastname: Hogue
authors.forename: Nils
authors.initials: N
authors.lastname: Åsenblad
authors.forename: Robert F
authors.initials: RF
authors.lastname: Storey
authors.forename: Ph Gabriel
authors.initials: PG
authors.lastname: Steg
authors.forename: Jay
authors.initials: J
authors.lastname: Horrow
authors.forename: Kenneth W
authors.initials: KW
authors.lastname: Mahaffey
authors.forename: Richard C
authors.initials: RC
authors.lastname: Becker
authors.forename: Stefan
authors.initials: S
authors.lastname: James
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Cannon
authors.forename: Gunnar
authors.initials: G
authors.lastname: Brandrup-Wognsen
authors.forename: Lars
authors.initials: L
authors.lastname: Wallentin
authors.forename: Claes
authors.initials: C
authors.lastname: Held
mesh_terms: D054058:Acute Coronary Syndrome / Q000188:drug therapy / Q000401:mortality / Q000601:surgery*; D000241:Adenosine / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000077144:Clopidogrel; D001026:Coronary Artery Bypass / Q000401:mortality*; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D004562:Electrocardiography; D005060:Europe / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use; D011446:Prospective Studies; D058921:Purinergic P2Y Receptor Antagonists / Q000008:administration & dosage / Q000627:therapeutic use; D015996:Survival Rate / Q000639:trends; D000077486:Ticagrelor; D013988:Ticlopidine / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors; D058921:Purinergic P2Y Receptor Antagonists; D000077144:Clopidogrel; D000077486:Ticagrelor; D000241:Adenosine; D013988:Ticlopidine