title: Effect of ticagrelor on the outcomes of patients with prior coronary artery bypass graft surgery: insights from the PLATelet inhibition and patient outcomes (PLATO) trial.
abstract: BACKGROUND
  Patients with prior coronary artery bypass graft surgery (CABG) who present with an acute coronary syndrome have a high risk for recurrent events. Whether intensive antiplatelet therapy with ticagrelor might be beneficial compared with clopidogrel is unknown. In this substudy of the PLATO trial, we studied the effects of randomized treatment dependent on history of CABG.
  
  
  METHODS
  Patients participating in PLATO were classified according to whether they had undergone prior CABG. The trial's primary and secondary end points were compared using Cox proportional hazards regression.
  
  
  RESULTS
  Of the 18,613 study patients, 1,133 (6.1%) had prior CABG. Prior-CABG patients had more high-risk characteristics at study entry and a 2-fold increase in clinical events during follow-up, but less major bleeding. The primary end point (composite of cardiovascular death, myocardial infarction, and stroke) was reduced to a similar extent by ticagrelor among patients with (19.6% vs 21.4%; adjusted hazard ratio [HR], 0.91 [0.67, 1.24]) and without (9.2% vs 11.0%; adjusted HR, 0.86 [0.77, 0.96]; P(interaction) = .73) prior CABG. Major bleeding was similar with ticagrelor versus clopidogrel among patients with (8.1% vs 8.7%; adjusted HR, 0.89 [0.55, 1.47]) and without (11.8% vs 11.4%; HR, 1.08 [0.98, 1.20]; P(interaction) = .46) prior CABG.
  
  
  CONCLUSIONS
  Prior-CABG patients presenting with acute coronary syndrome are a high-risk cohort for death and recurrent cardiovascular events but have a lower risk for major bleeding. Similar to the results in no-prior-CABG patients, ticagrelor was associated with a reduction in ischemic events without an increase in major bleeding.
authors.affiliation: VA North Texas Healthcare System and UT Southwestern Medical Center, Dallas, TX. Electronic address: esbrilakis@yahoo.com.
authors.forename: Emmanouil S
authors.initials: ES
authors.lastname: Brilakis
authors.forename: Claes
authors.initials: C
authors.lastname: Held
authors.forename: Bernhard
authors.initials: B
authors.lastname: Meier
authors.forename: Frank
authors.initials: F
authors.lastname: Cools
authors.forename: Marc J
authors.initials: MJ
authors.lastname: Claeys
authors.forename: Jan H
authors.initials: JH
authors.lastname: Cornel
authors.forename: Philip
authors.initials: P
authors.lastname: Aylward
authors.forename: Basil S
authors.initials: BS
authors.lastname: Lewis
authors.forename: Douglas
authors.initials: D
authors.lastname: Weaver
authors.forename: Gunnar
authors.initials: G
authors.lastname: Brandrup-Wognsen
authors.forename: Susanna R
authors.initials: SR
authors.lastname: Stevens
authors.forename: Anders
authors.initials: A
authors.lastname: Himmelmann
authors.forename: Lars
authors.initials: L
authors.lastname: Wallentin
authors.forename: Stefan K
authors.initials: SK
authors.lastname: James
mesh_terms: D054058:Acute Coronary Syndrome / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery; D000241:Adenosine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000368:Aged; D001026:Coronary Artery Bypass / Q000379:methods*; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced* / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000209:etiology*; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D016016:Proportional Hazards Models; D058921:Purinergic P2Y Receptor Antagonists / Q000627:therapeutic use*; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology / Q000209:etiology*; D016019:Survival Analysis; D000077486:Ticagrelor; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors; D058921:Purinergic P2Y Receptor Antagonists; D000077486:Ticagrelor; D000241:Adenosine