Reducing Cardiovascular Events in Patients with Acute Coronary Syndrome

A substudy of the PLATO trial reveals that treatment with ticagrelor reduces cardiovascular death, myocardial infarction, and stroke in some patients with non-ST-elevation acute coronary syndrome.

Study results presented at the American Heart Association 2012 Scientific Sessions, in Los Angeles, CA, show that ticagrelor, a platelet aggregation inhibitor, plays a significant role in reducing cardiovascular death, myocardial infarction, and stroke in patients with acute coronary syndrome.

In a poster presentation, titled “Outcomes with Ticagrelor Versus Clopidogrel in Relation to High Sensitivity Troponin-T in Non-ST-Elevation Acute Coronary Syndrome Patients Managed with Early Invasive or Non-Invasive Treatment - A Substudy from the Prospective Randomized PLATelet Inhibition and Patient Outcomes (PLATO) Trial,” lead authors Lars Wallentin, MD, PhD, Professor of Cardiology, Director of the Uppsala Clinical Research Center, University Hospital Uppsala, Sweden, and colleagues examined the effectiveness of ticagrelor in reducing cardiovascular events in patients with non-ST-elevation acute coronary syndrome (NSTE-ACS) and elevated high-sensitivity troponin-T (hs-TnT).

For the study, patients were determined to have NTSE-ACS based on the presence of two out three criteria (ST-segment depression, positive biomarker, or additional clinical indicator). Patients were followed for 6-12 months. Five-thousand three-hundred fifty-seven (5,357) patients underwent in-hospital revascularization and 4,589 did not during index hospitalization and with available hs-TnT.

The authors reported that in the 5,011 invasive patients with elevated hs-TnT, “ticagrelor reduced the composite of CV-death, MI and stroke from 11.2% to 8.5% based on a reduction of CV-death, spontaneous MI and procedure-related MI. In the 3576 non-invasive patients with elevated hs-TnT, ticagrelor reduced the composite of CV-death, MI and stroke from 14.9% to 12.4%, mainly driven by a reduction in CV-mortality.”

Adverse event rate “were very low” in the 1,013 non-invasive NSTE-ACS patients with normal hs-TnT.

The authors concluded that “patients with NSTE-ACS and elevated hs-TnT, ticagrelor improves survival, reduces CV-death and spontaneous and procedure related MI in invasively managed and reduces the composite of CV-death and spontaneous MI in non-invasively managed patients. The results emphasize that ticagrelor has its largest effect in ACS patients with elevated troponin regardless of invasive or non-invasive management.”