Pontus Andell , MD , 1 , Stefan K. James , MD, PhD 2 , Christopher P. Cannon , MD 3 , 4 , Derek D. Cyr , PhD 5 , Anders Himmelmann , MD, PhD 6 , Steen Husted , MD, DSc 7 , Matyas Keltai , MD, PhD 8 , Sasha Koul , MD 1 , Anwar Santoso , MD, PhD 9 , Ph. Gabriel Steg , MD 10 , 11 , 12 , 13 , Robert F. Storey , MD, DM 14 , Lars Wallentin , MD, PhD 2 , David Erlinge , MD, PhD 1 the PLATO Investigators
09 October 2015
Patients with chronic obstructive pulmonary disease ( COPD) experiencing acute coronary syndromes ( ACS) are at high risk for clinical events. In the Platelet Inhibition and Patient Outcomes ( PLATO) trial, ticagrelor versus clopidogrel reduced the primary endpoint of death from vascular causes, myocardial infarction, or stroke after ACS, but increased the incidence of dyspnea, which may lead clinicians to withhold ticagrelor from COPD patients.
In 18 624 patients with ACS randomized to treatment with ticagrelor or clopidogrel, history of COPD was recorded in 1085 (5.8%). At 1 year, the primary endpoint occurred in 17.7% of patients with COPD versus 10.4% in those without COPD ( P<0.001). The 1‐year event rate for the primary endpoint in COPD patients treated with ticagrelor versus clopidogrel was 14.8% versus 20.6% (hazard ratio [ HR]=0.72; 95% confidence interval [ CI]: 0.54 to 0.97), for death from any cause 8.4% versus 12.4% ( HR=0.70; 95% CI: 0.47 to 1.04), and for PLATO‐defined major bleeding rates at 1 year 14.6% versus 16.6% ( HR=0.85; 95% CI: 0.61 to 1.17). Dyspnea occurred more frequently with ticagrelor (26.1% vs. 16.3%; HR=1.71; 95% CI: 1.28 to 2.30). There was no differential increase in the relative risk of dyspnea compared to non‐ COPD patients ( HR=1.85). No COPD status‐by‐treatment interactions were found, showing consistency with the main trial results.
In this post‐hoc analysis, COPD patients experienced high rates of ischemic events. Ticagrelor versus clopidogrel reduced and substantially decreased the absolute risk of ischemic events (5.8%) in COPD patients, without increasing overall major bleeding events. The benefit‐risk profile supports the use of ticagrelor in patients with ACS and concomitant COPD.
URL: http://www.clinicaltrials.gov. Unique identifier: NCT00391872.