title: Ticagrelor Versus Clopidogrel in Patients With Acute Coronary Syndromes and Chronic Obstructive Pulmonary Disease: An Analysis From the Platelet Inhibition and Patient Outcomes (PLATO) Trial.
abstract: BACKGROUND
  Patients with chronic obstructive pulmonary disease (COPD) experiencing acute coronary syndromes (ACS) are at high risk for clinical events. In the Platelet Inhibition and Patient Outcomes (PLATO) trial, ticagrelor versus clopidogrel reduced the primary endpoint of death from vascular causes, myocardial infarction, or stroke after ACS, but increased the incidence of dyspnea, which may lead clinicians to withhold ticagrelor from COPD patients.
  
  
  RESULTS
  In 18 624 patients with ACS randomized to treatment with ticagrelor or clopidogrel, history of COPD was recorded in 1085 (5.8%). At 1 year, the primary endpoint occurred in 17.7% of patients with COPD versus 10.4% in those without COPD (P<0.001). The 1-year event rate for the primary endpoint in COPD patients treated with ticagrelor versus clopidogrel was 14.8% versus 20.6% (hazard ratio [HR]=0.72; 95% confidence interval [CI]: 0.54 to 0.97), for death from any cause 8.4% versus 12.4% (HR=0.70; 95% CI: 0.47 to 1.04), and for PLATO-defined major bleeding rates at 1 year 14.6% versus 16.6% (HR=0.85; 95% CI: 0.61 to 1.17). Dyspnea occurred more frequently with ticagrelor (26.1% vs. 16.3%; HR=1.71; 95% CI: 1.28 to 2.30). There was no differential increase in the relative risk of dyspnea compared to non-COPD patients (HR=1.85). No COPD status-by-treatment interactions were found, showing consistency with the main trial results.
  
  
  CONCLUSIONS
  In this post-hoc analysis, COPD patients experienced high rates of ischemic events. Ticagrelor versus clopidogrel reduced and substantially decreased the absolute risk of ischemic events (5.8%) in COPD patients, without increasing overall major bleeding events. The benefit-risk profile supports the use of ticagrelor in patients with ACS and concomitant COPD.
  
  
  BACKGROUND
  URL: http://www.clinicaltrials.gov. Unique identifier: NCT00391872.
authors.affiliation: Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden (P.A., S.K., D.E.).
authors.forename: Pontus
authors.initials: P
authors.lastname: Andell
authors.affiliation: Department of Medical Sciences, Cardiology and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden (S.K.J., L.W.).
authors.forename: Stefan K
authors.initials: SK
authors.lastname: James
authors.affiliation: Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (C.P.C.) Harvard Clinical Research Institute, Boston, MA (C.P.C.).
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Cannon
authors.affiliation: Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (D.D.C.).
authors.forename: Derek D
authors.initials: DD
authors.lastname: Cyr
authors.affiliation: AstraZeneca Research and Development, Mölndal, Sweden (A.H.).
authors.forename: Anders
authors.initials: A
authors.lastname: Himmelmann
authors.affiliation: Medical Department, Hospital Unit West, Herning/Holstebro, Denmark (S.H.).
authors.forename: Steen
authors.initials: S
authors.lastname: Husted
authors.affiliation: Hungarian Institute of Cardiology, Semmelweis University, Budapest, Hungary (M.K.).
authors.forename: Matyas
authors.initials: M
authors.lastname: Keltai
authors.affiliation: Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden (P.A., S.K., D.E.).
authors.forename: Sasha
authors.initials: S
authors.lastname: Koul
authors.affiliation: Department of Cardiology, Vascular Medicine, Faculty of Medicine, Harapan Kita Hospital, National Cardiovascular Center, University of Indonesia, Jakarta, Indonesia (A.S.).
authors.forename: Anwar
authors.initials: A
authors.lastname: Santoso
authors.affiliation: INSERM-Unité 1148, Paris, France (P.G.S.) Département Hospitalo-Universitaire FIRE, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, Paris, France (P.G.S.) Sorbonne-Paris Cité, Université Paris-Diderot, Paris, France (P.G.S.) NHLI Imperial College, ICMS, Royal Brompton Hospital, London, UK (P.G.S.).
authors.forename: Ph Gabriel
authors.initials: PG
authors.lastname: Steg
authors.affiliation: Department of Cardiovascular Science, University of Sheffield Sheffield, UK (R.F.S.).
authors.forename: Robert F
authors.initials: RF
authors.lastname: Storey
authors.affiliation: Department of Medical Sciences, Cardiology and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden (S.K.J., L.W.).
authors.forename: Lars
authors.initials: L
authors.lastname: Wallentin
authors.affiliation: Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden (P.A., S.K., D.E.).
authors.forename: David
authors.initials: D
authors.lastname: Erlinge
mesh_terms: D054058:Acute Coronary Syndrome / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D000241:Adenosine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000368:Aged; D000077144:Clopidogrel; D004417:Dyspnea / Q000139:chemically induced; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D016016:Proportional Hazards Models; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications* / Q000175:diagnosis / Q000401:mortality; D018570:Risk Assessment; D012307:Risk Factors; D000077486:Ticagrelor; D013988:Ticlopidine / Q000009:adverse effects / 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: cardiovascular diseases; lung; myocardial infarction