Ticagrelor versus clopidogrel in acute coronary syndromes in relation to renal function

• Verfasst von: James, Stefan [VerfasserIn]
• Verfasst von: Budaj, Andrzej [VerfasserIn]
• Verfasst von: Aylward, Philip [VerfasserIn]
• Verfasst von: Buck, Kristen K. [VerfasserIn]
• Verfasst von: Cannon, Christopher P. [VerfasserIn]
• Verfasst von: Cornel, Jan H. [VerfasserIn]
• Verfasst von: Harrington, Robert A. [VerfasserIn]
• Verfasst von: Horrow, Jay [VerfasserIn]
• Verfasst von: Katus, Hugo [VerfasserIn]
• Verfasst von: Keltai, Matyas [VerfasserIn]
• Verfasst von: Lewis, Basil S. [VerfasserIn]
• Verfasst von: Parikh, Keyur [VerfasserIn]
• Verfasst von: Storey, Robert F. [VerfasserIn]
• Verfasst von: Szummer, Karolina [VerfasserIn]
• Verfasst von: Wojdyla, Daniel [VerfasserIn]
• Verfasst von: Wallentin, Lars [VerfasserIn]
• Titel: Ticagrelor versus clopidogrel in acute coronary syndromes in relation to renal function
• Titelzusatz: results from the Platelet inhibition and patient outcomes (PLATO) trial
• Verf.angabe: Stefan James, Andrzej Budaj, Philip Aylward, Kristen K. Buck, Christopher P. Cannon, Jan H. Cornel, Robert A. Harrington, Jay Horrow, Hugo Katus, Matyas Keltai, Basil S. Lewis, Keyur Parikh, Robert F. Storey, Karolina Szummer, Daniel Wojdyla, and Lars Wallentin
• E-Jahr: 2010
• Jahr: [September 14, 2010]
• Umfang: 12 S.
• Illustrationen: Diagramme
• Fussnoten: Originally published 30 Aug 2010 ; Gesehen am 14.07.2023
• Titel Quelle: Enthalten in: Circulation
• Ort Quelle: Philadelphia, Pa. : Lippincott, Williams & Wilkins, 1950
• Jahr Quelle: 2010
• Band/Heft Quelle: 122(2010), 11 vom: Sept., Seite 1056-1067
• ISSN Quelle: 1524-4539
• DOI: doi:10.1161/CIRCULATIONAHA.109.933796
• Datenträger: Online-Ressource
• Sprache: eng
• Sach-SW: acute coronary syndrome
• Sach-SW: bleeding
• Sach-SW: clopidogrel
• Sach-SW: mortality
• Sach-SW: myocardial infarction
• Sach-SW: renal function
• K10plus-PPN: 1852708506

Abstract

Background—Reduced renal function is associated with a poorer prognosis and increased bleeding risk in patients with acute coronary syndromes and may therefore alter the risk-benefit ratio with antiplatelet therapies. In the Platelet Inhibition and Patient Outcomes (PLATO) trial, ticagrelor compared with clopidogrel reduced the primary composite end point of cardiovascular death, myocardial infarction, and stroke at 12 months but with similar major bleeding rates. - - Methods and Results—Central laboratory serum creatinine levels were available in 15 202 (81.9%) acute coronary syndrome patients at baseline, and creatinine clearance, estimated by the Cockcroft Gault equation, was calculated. In patients with chronic kidney disease (creatinine clearance <60 mL/min; n=3237), ticagrelor versus clopidogrel significantly reduced the primary end point to 17.3% from 22.0% (hazard ratio [HR], 0.77; 95% confidence interval [CI], 0.65 to 0.90) with an absolute risk reduction greater than that of patients with normal renal function (n=11 965): 7.9% versus 8.9% (HR, 0.90; 95% CI, 0.79 to 1.02). In patients with chronic kidney disease, ticagrelor reduced total mortality (10.0% versus 14.0%; HR, 0.72; 95% CI, 0.58 to 0.89). Major bleeding rates, fatal bleedings, and non-coronary bypass-related major bleedings were not significantly different between the 2 randomized groups (15.1% versus 14.3%; HR, 1.07; 95% CI, 0.88 to 1.30; 0.34% versus 0.77%; HR, 0.48; 95% CI, 0.15 to 1.54; and 8.5% versus 7.3%; HR, 1.28; 95% CI, 0.97 to 1.68). The interactions between creatinine clearance and randomized treatment on any of the outcome variables were nonsignificant. - - Conclusions—In acute coronary syndrome patients with chronic kidney disease, ticagrelor compared with clopidogrel significantly reduces ischemic end points and mortality without a significant increase in major bleeding but with numerically more non-procedure-related bleeding. - - Clinical Trial Registration—URL:http://www.clinicatrials.gov. Unique identifier: NCT00391872.