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Ticagrelor vs Clopidogrel for Complex Percutaneous Coronary Intervention in Chronic Coronary Syndrome
B. Lattuca, C. Mazeau, G. Cayla, G. Ducrocq, P. Guedeney, M. Laredo, R. Dumaine, M. El Kasty, P. Kala, M. Nejjari, O. Hlinomaz, O. Morel, O. Varenne, F. Leclercq, L. Payot, C. Spaulding, F. Beygui, G. Rangé, Z. Motovska, JJ. Portal, E. Vicaut,...
Jazyk angličtina Země Spojené státy americké
Typ dokumentu randomizované kontrolované studie, časopisecké články
- MeSH
- akutní koronární syndrom * diagnostické zobrazování terapie komplikace MeSH
- infarkt myokardu * etiologie MeSH
- inhibitory agregace trombocytů škodlivé účinky terapeutické užití MeSH
- klopidogrel škodlivé účinky terapeutické užití MeSH
- koronární angioplastika * škodlivé účinky MeSH
- lidé MeSH
- ticagrelor škodlivé účinky terapeutické užití MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- randomizované kontrolované studie MeSH
BACKGROUND: Whether ticagrelor in chronic coronary syndrome patients undergoing complex percutaneous coronary intervention (PCI) can prevent cardiovascular events is unknown. OBJECTIVES: The authors sought to evaluate outcomes of complex PCI and the efficacy of ticagrelor vs clopidogrel in stable patients randomized in the ALPHEUS (Assessment of Loading with the P2Y12 inhibitor ticagrelor or clopidogrel to Halt ischemic Events in patients Undergoing elective coronary Stenting) trial. METHODS: All PCI procedures were blindly reviewed and classified as complex if they had at least 1 of the following criteria: stent length >60 mm, 2-stent bifurcation, left main, bypass graft, chronic total occlusion, use of atherectomy or guiding catheter extensions, multiwire technique, multiple stents. The primary endpoint was a composite of type 4a or b myocardial infarction (MI) and major myocardial injury during the 48 hours after PCI. We compared the event rates according to the presence or not of complex PCI criteria and evaluated the interaction with ticagrelor or clopidogrel. RESULTS: Among the 1,866 patients randomized, 910 PCI (48.3%) were classified as complex PCI. The primary endpoint was more frequent in complex PCI (45.6% vs 26.6%; P < 0.001) driven by higher rates of type 4 MI and angiographic complications (12.2% vs 4.8 %; P < 0.001 and 19.3% vs 8.6%; P < 0.05, respectively). The composite of death, MI, and stroke at 48 hours (12.7% vs 5.1 %; P < 0.05) and at 30 days (13.4% vs 5.3%; P < 0.05) was more frequent in complex PCI. No interaction was found between PCI complexity and the randomized treatment for the primary endpoint (Pinteraction = 0.47) nor the secondary endpoints. CONCLUSIONS: In chronic coronary syndrome, patients undergoing a complex PCI have higher rates of periprocedural and cardiovascular events that are not reduced by ticagrelor as compared with clopidogrel.
Cardiology Department Caen University Hospital ACTION Study Group Caen France
Cardiology Department Centre Cardiologique du Nord Paris France
Cardiology Department Chartres Hospital Chartres France
Cardiology Department General Hospital Yves Le Foll Saint Brieuc France
Department of Cardiology Arnaud de Villeneuve Hospital Montpellier University Montpellier France
Les Grands Prés Cardiac Rehabilitation Centre Villeneuve St Denis France
Sorbonne Université ACTION Study Group INSERM UMRS1166 Hôpital Pitié Salpêtrière Paris France
University Hospital Brno Medical Faculty of Masaryk University Brno Brno Czech Republic
Citace poskytuje Crossref.org
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