title: Safety and efficacy of ticagrelor and clopidogrel in primary percutaneous coronary intervention.
abstract: OBJECTIVE
  The effects of ticagrelor in the subpopulation of patients with ST-elevation myocardial infarction (STEMI) were consistent with those observed in the overall Platelet Inhibition and Patient Outcomes (PLATO) study. However, this subgroup included patients initially or ultimately treated conservatively. The aim of this study is to compare treatment using ticagrelor with treatment using clopidogrel in patients with STEMI undergoing primary percutaneous coronary intervention (PCI).
  
  
  METHODS
  This post-hoc subgroup analysis compared ticagrelor with clopidogrel in 4949 PLATO patients with STEMI that were treated with primary PCI within 12 h of admission. The primary endpoint was cardiovascular death, myocardial infarction or stroke. The safety endpoint consisted of any major bleeding. Secondary endpoints included stent thrombosis. The analysis was not adequately powered to establish significance of any treatment effects.
  
  
  RESULTS
  During a median of 286 days, the primary endpoint occurred in 7.9% of ticagrelor-treated patients versus 8.6% of clopidogrel-treated patients (HR 0.91, 95% CI 0.75 to 1.12, p=0.38). Major bleeding occurred in 6.7% in ticagrelor-treated patients versus 6.8% of clopidogrel-treated patients (HR 0.97, 95% CI 0.77 to 1.22, p=0.79). No interactions were observed for the treatment effect of ticagrelor versus clopidogrel on the primary efficacy (p=0.40) and primary safety endpoints (p=0.15) as compared with the full PLATO population. Treatment with ticagrelor versus clopidogrel reduced the occurrence of definite stent thrombosis (HR 0.58, 95% CI 0.37 to 0.89, p=0.013).
  
  
  CONCLUSIONS
  In the subset of patients with STEMI treated with primary PCI, ticagrelor compared with clopidogrel was safe, and efficacy outcomes were consistent with the overall PLATO trial.
  
  
  BACKGROUND
  NCT00391872; Results.
authors: Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden.
authors: Matthijs A
authors: MA
authors: Velders
authors: Assistance Publique-Hôpitaux de Paris, Département Hospitalo-Universitaire FIRE, Hôpital Bichat, Paris, France.
authors: Jérémie
authors: J
authors: Abtan
authors: Department of Medicine, University of Florida College of Medicine-Jacksonville, Jacksonville, Florida, USA.
authors: Dominick J
authors: DJ
authors: Angiolillo
authors: Azienda Ospedaliero, Universitaria di Parma, Parma, Italy.
authors: Diego
authors: D
authors: Ardissino
authors: Department of Medicine, Stanford University, Stanford, California, USA.
authors: Robert A
authors: RA
authors: Harrington
authors: Duke Clinical Research Institute, Duke University, Medical Center, Durham, North Carolina, USA.
authors: Anne
authors: A
authors: Hellkamp
authors: AstraZeneca Research and Development, Gothenburg, Sweden.
authors: Anders
authors: A
authors: Himmelmann
authors: Medical Department, Hospital Unit West, Holstebro - Herning/Holstebro, Denmark.
authors: Steen
authors: S
authors: Husted
authors: Medizinishe Klinik, Universitätsklinikum Heidelberg, Heidelberg, Germany.
authors: Hugo A
authors: HA
authors: Katus
authors: Bern University Hospital, Bern, Switzerland.
authors: Bernhard
authors: B
authors: Meier
authors: Duke Clinical Research Institute, Duke University, Medical Center, Durham, North Carolina, USA Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA.
authors: Phillip J
authors: PJ
authors: Schulte
authors: Department of Cardiovascular Science, University of Sheffield, Sheffield, UK.
authors: Robert F
authors: RF
authors: Storey
authors: Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden.
authors: Lars
authors: L
authors: Wallentin
authors: Assistance Publique-Hôpitaux de Paris, Département Hospitalo-Universitaire FIRE, Hôpital Bichat, Paris, France INSERM-Unité 1148, Paris, France Université Paris-Diderot, Sorbonne-Paris Cité, Paris, France NHLI Imperial College, ICMS, Royal Brompton Hospital, London, UK.
authors: Philippe
authors: P
authors: Gabriel Steg
authors: Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden.
authors: Stefan K
authors: SK
authors: James
mesh_terms: D000241:Adenosine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000368:Aged; D000077144:Clopidogrel; D003131:Combined Modality Therapy; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000628:therapy*; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D058921:Purinergic P2Y Receptor Antagonists / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D000077486:Ticagrelor; D013988:Ticlopidine / Q000008:administration & dosage / Q000009:adverse effects / 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