TY - JOUR
T1 - Ticagrelor versus clopidogrel in elderly patients with acute coronary syndromes
T2 - A substudy from the prospective randomized PLATelet inhibition and patient Outcomes (PLATO) trial
AU - Husted, Steen
AU - James, Stefan
AU - Becker, Richard C.
AU - Horrow, Jay
AU - Katus, Hugo
AU - Storey, Robert F.
AU - Cannon, Christopher P.
AU - Heras, Magda
AU - Lopes, Renato D.
AU - Morais, Joao
AU - Mahaffey, Kenneth W.
AU - Bach, Richard G.
AU - Wojdyla, Daniel
AU - Wallentin, Lars
PY - 2012/9
Y1 - 2012/9
N2 - Background: Elderly patients with acute coronary syndrome are at high risk of recurrent ischemic events and death, and for both antithrombotic therapy and catheter-based complications. This prespecifed analysis investigates the effect and treatment-related complications of ticagrelor versus clopidogrel in elderly patients (≥75 years of age) with acute coronary syndrome compared with those <75 years of age. Methods and Results: The association between age and the primary composite outcome, as well as major bleeding were evaluated in the PLATelet inhibition and patient Outcomes (PLATO) trial using Cox proportional hazards. Similar models were used to evaluate the interaction of age with treatment effects. Hazard ratios were adjusted for baseline characteristics. The clinical benefit of ticagrelor over clopidogrel was not significantly different between patients aged ≥75 years of age (n=2878) and those <75 years of age (n=15 744) with respect to the composite of cardiovascular death, myocardial infarction, or stroke (interaction P=0.56), myocardial infarction (P=0.33), cardiovascular death (P=0.47), definite stent thrombosis (P=0.81), or all-cause mortality (P=0.76). No increase in PLATO-defined overall major bleeding with ticagrelor versus clopidogrel was observed in patients aged ≥75 years (hazard ratio, 1.02;95% confdence interval, 0.82-1.27) or patients aged <75 years (hazard ratio, 1.04;95% confdence interval, 0.94-1.15). Dyspnea and ventricular pauses were more common during ticagrelor than clopidogrel treatment, with no evidence of an age-by-treatment interaction. Conclusions: The significant clinical benefit and overall safety of ticagrelor compared with clopidogrel in acute coronary syndrome patients in the PLATO cohort were not found to depend on age. Clinical Trial Registration: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00391872.
AB - Background: Elderly patients with acute coronary syndrome are at high risk of recurrent ischemic events and death, and for both antithrombotic therapy and catheter-based complications. This prespecifed analysis investigates the effect and treatment-related complications of ticagrelor versus clopidogrel in elderly patients (≥75 years of age) with acute coronary syndrome compared with those <75 years of age. Methods and Results: The association between age and the primary composite outcome, as well as major bleeding were evaluated in the PLATelet inhibition and patient Outcomes (PLATO) trial using Cox proportional hazards. Similar models were used to evaluate the interaction of age with treatment effects. Hazard ratios were adjusted for baseline characteristics. The clinical benefit of ticagrelor over clopidogrel was not significantly different between patients aged ≥75 years of age (n=2878) and those <75 years of age (n=15 744) with respect to the composite of cardiovascular death, myocardial infarction, or stroke (interaction P=0.56), myocardial infarction (P=0.33), cardiovascular death (P=0.47), definite stent thrombosis (P=0.81), or all-cause mortality (P=0.76). No increase in PLATO-defined overall major bleeding with ticagrelor versus clopidogrel was observed in patients aged ≥75 years (hazard ratio, 1.02;95% confdence interval, 0.82-1.27) or patients aged <75 years (hazard ratio, 1.04;95% confdence interval, 0.94-1.15). Dyspnea and ventricular pauses were more common during ticagrelor than clopidogrel treatment, with no evidence of an age-by-treatment interaction. Conclusions: The significant clinical benefit and overall safety of ticagrelor compared with clopidogrel in acute coronary syndrome patients in the PLATO cohort were not found to depend on age. Clinical Trial Registration: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00391872.
KW - Acute coronary syndrome
KW - Age factors
KW - Bleeding
KW - P2Y receptor
KW - Platelets
KW - Thrombosis
UR - http://www.scopus.com/inward/record.url?scp=84868648318&partnerID=8YFLogxK
U2 - 10.1161/CIRCOUTCOMES.111.964395
DO - 10.1161/CIRCOUTCOMES.111.964395
M3 - Article
C2 - 22991347
AN - SCOPUS:84868648318
SN - 1941-7713
VL - 5
SP - 680
EP - 688
JO - Circulation: Cardiovascular Quality and Outcomes
JF - Circulation: Cardiovascular Quality and Outcomes
IS - 5
ER -