Evidence map›Paper›PMID 26452988›Full record

Trial reportJournal of the American Heart Association2015

Ticagrelor Versus Clopidogrel in Patients With Acute Coronary Syndromes and Chronic Obstructive Pulmonary Disease: An Analysis From the Platelet Inhibition and Patient Outcomes (PLATO) Trial.

Pontus Andell, Stefan K James, Christopher P Cannon, Derek D Cyr, Anders Himmelmann, Steen Husted, Matyas Keltai, Sasha Koul, Anwar Santoso, Ph Gabriel Steg and 4 more

2 registry-linked trialsOpen access · goldAbstract readComparative StudyMulticenter StudyRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Journal of the American Heart Association, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 2 registered trials, which are not on this map. Cited by 27 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
27citing papers in PubMed, 1 pooled it
6.6field-weighted citation impact, top 3% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT00391872 phase3completednot on this map

A Randomised, Double-blind, Parallel Group, Phase 3, Efficacy and Safety Study of Ticagrelor Compared With Clopidogrel for Prevention of Vascular Events in Patients With Non-ST or ST Elevation Acute Coronary Syndromes (ACS) [PLATO- a Study of PLATelet Inhibition and Patient Outcomes]

TypeinterventionalSponsorAstraZenecaRan2006 to 2009Enrolled18,624ConditionsAcute Coronary SyndromeArmsTicagrelor, Clopidogrel
NCT04331145 phase4completednot on this mapstarted 2020, after this paper: background citation

REACTIC-TAVI Trial: Platelet REACtivity According to TICagrelor Dose After Transcatheter AorticValve Implantation. A Pilot Study.

TypeinterventionalSponsorAndres Iñiguez RomoRan2020 to 2022Enrolled40ConditionsSymptomatic Aortic StenosisArmsTicagrelor 60mg
3 · Its place in the literature

Who cites it

27 citing papers in PubMed, 1 synthesis or guideline pooled it, 66 citations in OpenAlex.

  1. Antiplatelet agents for chronic kidney disease.The Cochrane database of systematic reviews · 2022
    Pooled it
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  8. Article
  9. Review
  10. Extrapulmonary Comorbidities Associated with Chronic Obstructive Pulmonary Disease: A Review.International journal of chronic obstructive pulmonary disease · 2024
    Review
  11. Review
  12. Article
  13. Review
  14. Article
  15. Review
  16. Article
  17. Article
  18. COPD and acute myocardial infarction.European respiratory review : an official journal of the European Respiratory Society · 2020
    Review
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

14 authors at 10 institutions in 7 countries.

Pontus AndellDepartment of Cardiology, Clinical Sciences, Lund University, Lund, Sweden (P.A., S.K., D.E.).
Stefan K JamesDepartment of Medical Sciences, Cardiology and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden (S.K.J., L.W.).
Christopher P CannonCardiovascular Division, Brigham and Women's Hospital, Boston, MA (C.P.C.) Harvard Clinical Research Institute, Boston, MA (C.P.C.).
Derek D CyrDuke Clinical Research Institute, Duke University Medical Center, Durham, NC (D.D.C.).
Anders HimmelmannAstraZeneca Research and Development, Mölndal, Sweden (A.H.).
Steen HustedMedical Department, Hospital Unit West, Herning/Holstebro, Denmark (S.H.).
Matyas KeltaiHungarian Institute of Cardiology, Semmelweis University, Budapest, Hungary (M.K.).
Sasha KoulDepartment of Cardiology, Clinical Sciences, Lund University, Lund, Sweden (P.A., S.K., D.E.).
Anwar SantosoDepartment of Cardiology, Vascular Medicine, Faculty of Medicine, Harapan Kita Hospital, National Cardiovascular Center, University of Indonesia, Jakarta, Indonesia (A.S.).
Ph Gabriel StegINSERM-Unité 1148, Paris, France (P.G.S.) Département Hospitalo-Universitaire FIRE, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, Paris, France (P.G.S.) Sorbonne-Paris Cité, Université Paris-Diderot, Paris, France (P.G.S.) NHLI Imperial College, ICMS, Royal Brompton Hospital, London, UK (P.G.S.).
Robert F StoreyDepartment of Cardiovascular Science, University of Sheffield Sheffield, UK (R.F.S.).
Lars WallentinDepartment of Medical Sciences, Cardiology and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden (S.K.J., L.W.).
David ErlingeDepartment of Cardiology, Clinical Sciences, Lund University, Lund, Sweden (P.A., S.K., D.E.).
PLATO Investigators
Lund University · SEUppsala University · SEAstraZeneca (Sweden) · SEBrigham and Women's Hospital · USClinical Research Institute · USRegional Hospital West Jutland · DKSemmelweis University · HUUniversité Paris Cité · FRUniversity of Indonesia · IDUniversity of Sheffield · GB

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundPatients 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. METHODS AND

resultsIn 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.

conclusionsIn 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. CLINICAL

trial registrationURL: http://www.clinicaltrials.gov. Unique identifier: NCT00391872.

Indexed as

Acute Coronary SyndromeAdenosineAgedClopidogrelDyspneaFemaleHemorrhageHumansKaplan-Meier EstimateMaleMiddle AgedPlatelet Aggregation InhibitorsProportional Hazards ModelsPulmonary Disease, Chronic ObstructiveRisk AssessmentRisk FactorsAdenosineClopidogrelPlatelet Aggregation InhibitorsTicagrelorTiclopidinecardiovascular diseaseslungmyocardial infarction

Identifiers

PMID26452988
PMCPMC4845124
OpenAlexW2174087160

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.