title: Angiographic outcomes in the PLATO Trial (Platelet Inhibition and Patient Outcomes).
abstract: OBJECTIVE
  The PLATO (Platelet Inhibition and Patient Outcomes) angiographic substudy sought to compare the efficacy of ticagrelor versus clopidogrel with respect to angiographic outcomes before and after PCI in the setting of acute coronary syndrome.
  
  
  BACKGROUND
  Greater platelet inhibition has been associated with improved angiographic outcomes before and after percutaneous coronary intervention (PCI). Therefore, it was hypothesized that treatment with ticagrelor, which achieves more rapid, higher, and more consistent platelet inhibition, would be associated with improved angiographic outcomes when compared with those of clopidogrel treatment.
  
  
  METHODS
  The angiographic cohort consists of 2,616 patients drawn from the 18,624-patient PLATO trial. Clopidogrel naïve or pre-treated patients were randomized to 180 mg of ticagrelor or 300 mg of clopidogrel (75 mg for clopidogrel pre-treated patients). PCI patients were administered, as per treatment group: 1) an additional 90 mg of ticagrelor if >24 h following the initial loading dose; or 2) an optional further 300 mg of clopidogrel or placebo (total 600 mg) prior to PCI. The substudy primary endpoint was the incidence of post-PCI TIMI (Thrombolysis In Myocardial Infarction) myocardial perfusion grade 3 (TMPG 3) among patients who received a study drug prior to PCI.
  
  
  RESULTS
  In total, 21.3% of patients were pretreated with clopidogrel prior to randomization. There was a short time interval between randomization and PCI (median: 0.68 [interquartile range (IQR): 0.30 to 2.21] h) among all patients. Post-PCI TMPG 3 was similar between the ticagrelor and clopidogrel groups (47.1% vs. 46.9%; p = 0.96). Likewise, the following pre-PCI outcomes were similar in the ticagrelor and clopidogrel groups, respectively: TMPG 3 (30.5% vs. 31.2%), TIMI flow grade 3 (37.1% vs. 39.3%), corrected TIMI frame count (median: 100 vs. 71 frames), TIMI thrombus grade 0 (24.1% vs. 27.6%), minimum lumen diameter (median: 0.3 [IQR: 0.0 to 0.6] vs. 0.3 [IQR: 0.0 to 0.6] mm) and percentage of diameter stenosis (median: 89 [IQR: 78 to 100] vs. 89 [IQR: 77 to 100]).
  
  
  CONCLUSIONS
  Neither coronary flow nor myocardial perfusion, evaluated on coronary angiograms performed before or following PCI procedures within a few hours after the start of oral antiplatelet treatment in the setting of acute coronary syndromes, demonstrated a difference with ticagrelor versus clopidogrel. (A Comparison of Ticagrelor [AZD6140] and Clopidogrel in Patients With Acute Coronary Syndrome [PLATO]; NCT00391872).
authors.affiliation: Department of Cardiology, Institute of Cellular Medicine, Newcastle University and Cardiothoracic Centre, Freeman Hospital, Newcastle Upon Tyne Hospitals National Health Service Foundation Trust, Newcastle Upon Tyne, United Kingdom.
authors.forename: Vijay
authors.initials: V
authors.lastname: Kunadian
authors.forename: Stefan K
authors.initials: SK
authors.lastname: James
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Wojdyla
authors.forename: Cafer
authors.initials: C
authors.lastname: Zorkun
authors.forename: Jinhui
authors.initials: J
authors.lastname: Wu
authors.forename: Robert F
authors.initials: RF
authors.lastname: Storey
authors.forename: Ph Gabriel
authors.initials: PG
authors.lastname: Steg
authors.forename: Hugo
authors.initials: H
authors.lastname: Katus
authors.forename: Hakan
authors.initials: H
authors.lastname: Emanuelsson
authors.forename: Jay
authors.initials: J
authors.lastname: Horrow
authors.forename: Juan
authors.initials: J
authors.lastname: Maya
authors.forename: Lars
authors.initials: L
authors.lastname: Wallentin
authors.forename: Robert A
authors.initials: RA
authors.lastname: Harrington
authors.forename: C Michael
authors.initials: CM
authors.lastname: Gibson
mesh_terms: D054058:Acute Coronary Syndrome / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D000241:Adenosine / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000284:Administration, Oral; D000368:Aged; D000077144:Clopidogrel; D017023:Coronary Angiography; D003326:Coronary Circulation; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000517:prevention & control*; D003328:Coronary Thrombosis / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000517:prevention & control*; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000187:drug effects* / Q000503:physiopathology; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D011237:Predictive Value of Tests; D000077486:Ticagrelor; D013988:Ticlopidine / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D000077486:Ticagrelor; D000241:Adenosine; D013988:Ticlopidine
keywords: ACS; CTFC; IQR; MI; NSTE; PCI; PD; ST-segment elevation myocardial infarction; STEMI; TIMI; TIMI myocardial perfusion grade; TMPG; Thrombolysis In Myocardial Infarction; Thrombolysis in Myocardial Infarction; acute coronary syndromes; clopidogrel; corrected TIMI frame count; interquartile range; myocardial infarction; non–ST-segment elevation; percutaneous coronary intervention; pharmacodynamic; ticagrelor