title: Extent of coronary artery disease and outcomes after ticagrelor administration in patients with an acute coronary syndrome: Insights from the PLATelet inhibition and patient Outcomes (PLATO) trial.
abstract: BACKGROUND
  Extensive coronary artery disease (CAD) is associated with higher risk. In this substudy of the PLATO trial, we examined the effects of randomized treatment on outcome events and safety in relation to the extent of CAD.
  
  
  METHODS
  Patients were classified according to presence of extensive CAD (defined as 3-vessel disease, left main disease, or prior coronary artery bypass graft surgery). The trial's primary and secondary end points were compared using Cox proportional hazards regression.
  
  
  RESULTS
  Among 15,388 study patients for whom the extent of CAD was known, 4,646 (30%) had extensive CAD. Patients with extensive CAD had more high-risk characteristics and experienced more clinical events during follow-up. They were less likely to undergo percutaneous coronary intervention (58% vs 79%, P < .001) but more likely to undergo coronary artery bypass graft surgery (16% vs 2%, P < .001). Ticagrelor, compared with clopidogrel, reduced the composite of cardiovascular death, myocardial infarction, and stroke in patients with extensive CAD (14.9% vs 17.6%, hazard ratio [HR] 0.85 [0.73-0.98]) similar to its reduction in those without extensive CAD (6.8% vs 8.0%, HR 0.85 [0.74-0.98], Pinteraction = .99). Major bleeding was similar with ticagrelor vs clopidogrel among patients with (25.7% vs 25.5%, HR 1.02 [0.90-1.15]) and without (7.3% vs 6.4%, HR 1.14 [0.98-1.33], Pinteraction = .24) extensive CAD.
  
  
  CONCLUSIONS
  Patients with extensive CAD have higher rates of recurrent cardiovascular events and bleeding. Ticagrelor reduced ischemic events to a similar extent both in patients with and without extensive CAD, with bleeding rates similar to clopidogrel.
authors: VA North Texas Healthcare System and UT Southwestern Medical Center, Dallas, TX.
authors: Anna
authors: A
authors: Kotsia
authors: VA North Texas Healthcare System and UT Southwestern Medical Center, Dallas, TX. Electronic address: esbrilakis@yahoo.com.
authors: Emmanouil S
authors: ES
authors: Brilakis
authors: Department of Medical Sciences, Cardiology and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden.
authors: Claes
authors: C
authors: Held
authors: Thrombolysis in Myocardial Infarction (TIMI) Study Group, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.
authors: Christopher
authors: C
authors: Cannon
authors: INSERM-Unité 698, Paris, France; Assistance Publique-Hôpitaux de Paris, Département Hospitalo-Universitaire FIRE, Hôpital Bichat, Paris, France; Université Paris-Diderot, Sorbonne-Paris Cité, Paris, France; NHLI Imperial College, ICMS, Royal Brompton Hospital, London, United Kingdom.
authors: Gabriel P
authors: GP
authors: Steg
authors: Bern University Hospital, Bern, Switzerland.
authors: Bernhard
authors: B
authors: Meier
authors: AZ KLINA, Brasschaat, Antwerp, Belgium.
authors: Frank
authors: F
authors: Cools
authors: University Hospital Antwerp, Antwerp, Belgium.
authors: Marc J
authors: MJ
authors: Claeys
authors: Department of cardiology, Medisch Centrum Alkmaar, Alkmaar, The Netherlands.
authors: Jan H
authors: JH
authors: Cornel
authors: South Australian Health and Medical Research Institute, Flinders University and Medical Centre, Adelaide, Australia.
authors: Philip
authors: P
authors: Aylward
authors: Lady Davis Carmel Medical Center and the Ruth and Bruce Rappaport School of Medicine, Technion-ITT, Haifa, Israel.
authors: Basil S
authors: BS
authors: Lewis
authors: Henry Ford Heart and Vascular Institute, Detroit, MI.
authors: Douglas
authors: D
authors: Weaver
authors: AstraZeneca Research and Development, Mölndal, Sweden.
authors: Gunnar
authors: G
authors: Brandrup-Wognsen
authors: Duke Clinical Research Institute, Duke University Medical Center, Durham, NC.
authors: Susanna R
authors: SR
authors: Stevens
authors: AstraZeneca Research and Development, Mölndal, Sweden.
authors: Anders
authors: A
authors: Himmelmann
authors: Department of Medical Sciences, Cardiology and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden.
authors: Lars
authors: L
authors: Wallentin
authors: Department of Medical Sciences, Cardiology and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden.
authors: Stefan K
authors: SK
authors: James
mesh_terms: D054058:Acute Coronary Syndrome / Q000188:drug therapy* / Q000453:epidemiology; D000241:Adenosine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000368:Aged; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D014943:Global Health; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D058921:Purinergic P2Y Receptor Antagonists / Q000627:therapeutic use; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D000077486:Ticagrelor; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors; D058921:Purinergic P2Y Receptor Antagonists; D000077486:Ticagrelor; D000241:Adenosine