Evidence map›Paper›PMID 27840336›Full record

Trial reportCirculation2017

Ticagrelor Compared With Clopidogrel in Patients With Prior Lower Extremity Revascularization for Peripheral Artery Disease.

W Schuyler Jones, Iris Baumgartner, William R Hiatt, Gretchen Heizer, Michael S Conte, Christopher J White, Jeffrey S Berger, Peter Held, Brian G Katona, Kenneth W Mahaffey and 7 more

Registry-linked trialAbstract readRandomized Controlled Trial
PubMed Publisher
In one paragraph

Trial report in Circulation, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT01732822 (A Randomized, Double-blind, Parallel Group, Multicentre Phase IIIb Study to Compare Ticagrelor With Clopidogrel Treatment on the Risk of Cardiovascular Death, Myocardial Infarction and Ischemic Stroke in Patients With Established Peripheral Artery Disease), which is not on this map. Cited by 42 papers, 4 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
42citing papers in PubMed, 4 pooled it
–field-weighted citation impact
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.

NCT01732822 phase3completednot on this map

A Randomized, Double-blind, Parallel Group, Multicentre Phase IIIb Study to Compare Ticagrelor With Clopidogrel Treatment on the Risk of Cardiovascular Death, Myocardial Infarction and Ischemic Stroke in Patients With Established Peripheral Artery Disease (EUCLID Examining Use of tiCagreLor In paD)

TypeinterventionalSponsorAstraZenecaRan2012 to 2016Enrolled13,885ConditionsPeripheral Artery DiseaseArmsTicagrelor, Clopidogrel
3 · Its place in the literature

Who cites it

42 citing papers in PubMed, 4 syntheses or guidelines pooled it.

  1. Guideline
  2. Antiplatelet agents for chronic kidney disease.The Cochrane database of systematic reviews · 2022
    Pooled it
  3. Pooled it
  4. Pooled it
  5. Trial
  6. Trial
  7. Trial
  8. Trial
  9. Trial
  10. Paclitaxel-Coated Balloons for Femoropopliteal Artery Disease Treatment in French Patients: A Longitudinal Observational Study.Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions · 2025
    Observational
  11. Article
  12. Review
  13. Rationale and Design of the Latin-American Registry of Peripheral Interventions: Insights From SOLACI Peripheral.Journal of the Society for Cardiovascular Angiography & Interventions · 2024
    Article
  14. Article
  15. Article
  16. Article
  17. Article
  18. Article
  19. Article
  20. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

17 authors.

W Schuyler JonesFrom Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (W.S.J., G.H., C.R., M.P.P.); Swiss Cardiovascular Centre, Inselspital, Bern University Hospital, University of Bern, Switzerland (I.B.); University of Colorado School of Medicine and CPC Clinical Research, Aurora (W.R.H.); Department of Surgery, University of California San Francisco (M.S.C.); Department of Cardiology, Ochsner Clinical School, University of Queensland, Australia (C.J.W.); Ochsner Medical Center, New Orleans, LA (C.J.W.); Departments of Medicine and Surgery, New York University School of Medicine (J.S.B.); AstraZeneca Gothenburg, Mölndal, Sweden (P.H., J.B., M.M.); AstraZeneca Gaithersburg, MD (B.G.K.); Stanford Center for Clinical Research, Stanford University School of Medicine, CA (K.W.M.); Faculty of Medicine and Health, Örebro University, Sweden (L.N.); and Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, UK (F.G.R.F.).
Iris BaumgartnerFrom Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (W.S.J., G.H., C.R., M.P.P.); Swiss Cardiovascular Centre, Inselspital, Bern University Hospital, University of Bern, Switzerland (I.B.); University of Colorado School of Medicine and CPC Clinical Research, Aurora (W.R.H.); Department of Surgery, University of California San Francisco (M.S.C.); Department of Cardiology, Ochsner Clinical School, University of Queensland, Australia (C.J.W.); Ochsner Medical Center, New Orleans, LA (C.J.W.); Departments of Medicine and Surgery, New York University School of Medicine (J.S.B.); AstraZeneca Gothenburg, Mölndal, Sweden (P.H., J.B., M.M.); AstraZeneca Gaithersburg, MD (B.G.K.); Stanford Center for Clinical Research, Stanford University School of Medicine, CA (K.W.M.); Faculty of Medicine and Health, Örebro University, Sweden (L.N.); and Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, UK (F.G.R.F.).
William R HiattFrom Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (W.S.J., G.H., C.R., M.P.P.); Swiss Cardiovascular Centre, Inselspital, Bern University Hospital, University of Bern, Switzerland (I.B.); University of Colorado School of Medicine and CPC Clinical Research, Aurora (W.R.H.); Department of Surgery, University of California San Francisco (M.S.C.); Department of Cardiology, Ochsner Clinical School, University of Queensland, Australia (C.J.W.); Ochsner Medical Center, New Orleans, LA (C.J.W.); Departments of Medicine and Surgery, New York University School of Medicine (J.S.B.); AstraZeneca Gothenburg, Mölndal, Sweden (P.H., J.B., M.M.); AstraZeneca Gaithersburg, MD (B.G.K.); Stanford Center for Clinical Research, Stanford University School of Medicine, CA (K.W.M.); Faculty of Medicine and Health, Örebro University, Sweden (L.N.); and Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, UK (F.G.R.F.).
Gretchen HeizerFrom Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (W.S.J., G.H., C.R., M.P.P.); Swiss Cardiovascular Centre, Inselspital, Bern University Hospital, University of Bern, Switzerland (I.B.); University of Colorado School of Medicine and CPC Clinical Research, Aurora (W.R.H.); Department of Surgery, University of California San Francisco (M.S.C.); Department of Cardiology, Ochsner Clinical School, University of Queensland, Australia (C.J.W.); Ochsner Medical Center, New Orleans, LA (C.J.W.); Departments of Medicine and Surgery, New York University School of Medicine (J.S.B.); AstraZeneca Gothenburg, Mölndal, Sweden (P.H., J.B., M.M.); AstraZeneca Gaithersburg, MD (B.G.K.); Stanford Center for Clinical Research, Stanford University School of Medicine, CA (K.W.M.); Faculty of Medicine and Health, Örebro University, Sweden (L.N.); and Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, UK (F.G.R.F.).
Michael S ConteFrom Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (W.S.J., G.H., C.R., M.P.P.); Swiss Cardiovascular Centre, Inselspital, Bern University Hospital, University of Bern, Switzerland (I.B.); University of Colorado School of Medicine and CPC Clinical Research, Aurora (W.R.H.); Department of Surgery, University of California San Francisco (M.S.C.); Department of Cardiology, Ochsner Clinical School, University of Queensland, Australia (C.J.W.); Ochsner Medical Center, New Orleans, LA (C.J.W.); Departments of Medicine and Surgery, New York University School of Medicine (J.S.B.); AstraZeneca Gothenburg, Mölndal, Sweden (P.H., J.B., M.M.); AstraZeneca Gaithersburg, MD (B.G.K.); Stanford Center for Clinical Research, Stanford University School of Medicine, CA (K.W.M.); Faculty of Medicine and Health, Örebro University, Sweden (L.N.); and Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, UK (F.G.R.F.).
Christopher J WhiteFrom Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (W.S.J., G.H., C.R., M.P.P.); Swiss Cardiovascular Centre, Inselspital, Bern University Hospital, University of Bern, Switzerland (I.B.); University of Colorado School of Medicine and CPC Clinical Research, Aurora (W.R.H.); Department of Surgery, University of California San Francisco (M.S.C.); Department of Cardiology, Ochsner Clinical School, University of Queensland, Australia (C.J.W.); Ochsner Medical Center, New Orleans, LA (C.J.W.); Departments of Medicine and Surgery, New York University School of Medicine (J.S.B.); AstraZeneca Gothenburg, Mölndal, Sweden (P.H., J.B., M.M.); AstraZeneca Gaithersburg, MD (B.G.K.); Stanford Center for Clinical Research, Stanford University School of Medicine, CA (K.W.M.); Faculty of Medicine and Health, Örebro University, Sweden (L.N.); and Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, UK (F.G.R.F.).
Jeffrey S BergerFrom Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (W.S.J., G.H., C.R., M.P.P.); Swiss Cardiovascular Centre, Inselspital, Bern University Hospital, University of Bern, Switzerland (I.B.); University of Colorado School of Medicine and CPC Clinical Research, Aurora (W.R.H.); Department of Surgery, University of California San Francisco (M.S.C.); Department of Cardiology, Ochsner Clinical School, University of Queensland, Australia (C.J.W.); Ochsner Medical Center, New Orleans, LA (C.J.W.); Departments of Medicine and Surgery, New York University School of Medicine (J.S.B.); AstraZeneca Gothenburg, Mölndal, Sweden (P.H., J.B., M.M.); AstraZeneca Gaithersburg, MD (B.G.K.); Stanford Center for Clinical Research, Stanford University School of Medicine, CA (K.W.M.); Faculty of Medicine and Health, Örebro University, Sweden (L.N.); and Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, UK (F.G.R.F.).
Peter HeldFrom Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (W.S.J., G.H., C.R., M.P.P.); Swiss Cardiovascular Centre, Inselspital, Bern University Hospital, University of Bern, Switzerland (I.B.); University of Colorado School of Medicine and CPC Clinical Research, Aurora (W.R.H.); Department of Surgery, University of California San Francisco (M.S.C.); Department of Cardiology, Ochsner Clinical School, University of Queensland, Australia (C.J.W.); Ochsner Medical Center, New Orleans, LA (C.J.W.); Departments of Medicine and Surgery, New York University School of Medicine (J.S.B.); AstraZeneca Gothenburg, Mölndal, Sweden (P.H., J.B., M.M.); AstraZeneca Gaithersburg, MD (B.G.K.); Stanford Center for Clinical Research, Stanford University School of Medicine, CA (K.W.M.); Faculty of Medicine and Health, Örebro University, Sweden (L.N.); and Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, UK (F.G.R.F.).
Brian G KatonaFrom Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (W.S.J., G.H., C.R., M.P.P.); Swiss Cardiovascular Centre, Inselspital, Bern University Hospital, University of Bern, Switzerland (I.B.); University of Colorado School of Medicine and CPC Clinical Research, Aurora (W.R.H.); Department of Surgery, University of California San Francisco (M.S.C.); Department of Cardiology, Ochsner Clinical School, University of Queensland, Australia (C.J.W.); Ochsner Medical Center, New Orleans, LA (C.J.W.); Departments of Medicine and Surgery, New York University School of Medicine (J.S.B.); AstraZeneca Gothenburg, Mölndal, Sweden (P.H., J.B., M.M.); AstraZeneca Gaithersburg, MD (B.G.K.); Stanford Center for Clinical Research, Stanford University School of Medicine, CA (K.W.M.); Faculty of Medicine and Health, Örebro University, Sweden (L.N.); and Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, UK (F.G.R.F.).
Kenneth W MahaffeyFrom Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (W.S.J., G.H., C.R., M.P.P.); Swiss Cardiovascular Centre, Inselspital, Bern University Hospital, University of Bern, Switzerland (I.B.); University of Colorado School of Medicine and CPC Clinical Research, Aurora (W.R.H.); Department of Surgery, University of California San Francisco (M.S.C.); Department of Cardiology, Ochsner Clinical School, University of Queensland, Australia (C.J.W.); Ochsner Medical Center, New Orleans, LA (C.J.W.); Departments of Medicine and Surgery, New York University School of Medicine (J.S.B.); AstraZeneca Gothenburg, Mölndal, Sweden (P.H., J.B., M.M.); AstraZeneca Gaithersburg, MD (B.G.K.); Stanford Center for Clinical Research, Stanford University School of Medicine, CA (K.W.M.); Faculty of Medicine and Health, Örebro University, Sweden (L.N.); and Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, UK (F.G.R.F.).
Lars NorgrenFrom Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (W.S.J., G.H., C.R., M.P.P.); Swiss Cardiovascular Centre, Inselspital, Bern University Hospital, University of Bern, Switzerland (I.B.); University of Colorado School of Medicine and CPC Clinical Research, Aurora (W.R.H.); Department of Surgery, University of California San Francisco (M.S.C.); Department of Cardiology, Ochsner Clinical School, University of Queensland, Australia (C.J.W.); Ochsner Medical Center, New Orleans, LA (C.J.W.); Departments of Medicine and Surgery, New York University School of Medicine (J.S.B.); AstraZeneca Gothenburg, Mölndal, Sweden (P.H., J.B., M.M.); AstraZeneca Gaithersburg, MD (B.G.K.); Stanford Center for Clinical Research, Stanford University School of Medicine, CA (K.W.M.); Faculty of Medicine and Health, Örebro University, Sweden (L.N.); and Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, UK (F.G.R.F.).
Juuso BlomsterFrom Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (W.S.J., G.H., C.R., M.P.P.); Swiss Cardiovascular Centre, Inselspital, Bern University Hospital, University of Bern, Switzerland (I.B.); University of Colorado School of Medicine and CPC Clinical Research, Aurora (W.R.H.); Department of Surgery, University of California San Francisco (M.S.C.); Department of Cardiology, Ochsner Clinical School, University of Queensland, Australia (C.J.W.); Ochsner Medical Center, New Orleans, LA (C.J.W.); Departments of Medicine and Surgery, New York University School of Medicine (J.S.B.); AstraZeneca Gothenburg, Mölndal, Sweden (P.H., J.B., M.M.); AstraZeneca Gaithersburg, MD (B.G.K.); Stanford Center for Clinical Research, Stanford University School of Medicine, CA (K.W.M.); Faculty of Medicine and Health, Örebro University, Sweden (L.N.); and Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, UK (F.G.R.F.).
Marcus MillegårdFrom Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (W.S.J., G.H., C.R., M.P.P.); Swiss Cardiovascular Centre, Inselspital, Bern University Hospital, University of Bern, Switzerland (I.B.); University of Colorado School of Medicine and CPC Clinical Research, Aurora (W.R.H.); Department of Surgery, University of California San Francisco (M.S.C.); Department of Cardiology, Ochsner Clinical School, University of Queensland, Australia (C.J.W.); Ochsner Medical Center, New Orleans, LA (C.J.W.); Departments of Medicine and Surgery, New York University School of Medicine (J.S.B.); AstraZeneca Gothenburg, Mölndal, Sweden (P.H., J.B., M.M.); AstraZeneca Gaithersburg, MD (B.G.K.); Stanford Center for Clinical Research, Stanford University School of Medicine, CA (K.W.M.); Faculty of Medicine and Health, Örebro University, Sweden (L.N.); and Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, UK (F.G.R.F.).
Craig ReistFrom Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (W.S.J., G.H., C.R., M.P.P.); Swiss Cardiovascular Centre, Inselspital, Bern University Hospital, University of Bern, Switzerland (I.B.); University of Colorado School of Medicine and CPC Clinical Research, Aurora (W.R.H.); Department of Surgery, University of California San Francisco (M.S.C.); Department of Cardiology, Ochsner Clinical School, University of Queensland, Australia (C.J.W.); Ochsner Medical Center, New Orleans, LA (C.J.W.); Departments of Medicine and Surgery, New York University School of Medicine (J.S.B.); AstraZeneca Gothenburg, Mölndal, Sweden (P.H., J.B., M.M.); AstraZeneca Gaithersburg, MD (B.G.K.); Stanford Center for Clinical Research, Stanford University School of Medicine, CA (K.W.M.); Faculty of Medicine and Health, Örebro University, Sweden (L.N.); and Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, UK (F.G.R.F.).
Manesh R PatelFrom Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (W.S.J., G.H., C.R., M.P.P.); Swiss Cardiovascular Centre, Inselspital, Bern University Hospital, University of Bern, Switzerland (I.B.); University of Colorado School of Medicine and CPC Clinical Research, Aurora (W.R.H.); Department of Surgery, University of California San Francisco (M.S.C.); Department of Cardiology, Ochsner Clinical School, University of Queensland, Australia (C.J.W.); Ochsner Medical Center, New Orleans, LA (C.J.W.); Departments of Medicine and Surgery, New York University School of Medicine (J.S.B.); AstraZeneca Gothenburg, Mölndal, Sweden (P.H., J.B., M.M.); AstraZeneca Gaithersburg, MD (B.G.K.); Stanford Center for Clinical Research, Stanford University School of Medicine, CA (K.W.M.); Faculty of Medicine and Health, Örebro University, Sweden (L.N.); and Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, UK (F.G.R.F.).
F Gerry R FowkesFrom Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (W.S.J., G.H., C.R., M.P.P.); Swiss Cardiovascular Centre, Inselspital, Bern University Hospital, University of Bern, Switzerland (I.B.); University of Colorado School of Medicine and CPC Clinical Research, Aurora (W.R.H.); Department of Surgery, University of California San Francisco (M.S.C.); Department of Cardiology, Ochsner Clinical School, University of Queensland, Australia (C.J.W.); Ochsner Medical Center, New Orleans, LA (C.J.W.); Departments of Medicine and Surgery, New York University School of Medicine (J.S.B.); AstraZeneca Gothenburg, Mölndal, Sweden (P.H., J.B., M.M.); AstraZeneca Gaithersburg, MD (B.G.K.); Stanford Center for Clinical Research, Stanford University School of Medicine, CA (K.W.M.); Faculty of Medicine and Health, Örebro University, Sweden (L.N.); and Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, UK (F.G.R.F.). schuyler.jones@duke.edu.
International Steering Committee and Investigators of the EUCLID Trial

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundIn patients with symptomatic peripheral artery disease with a history of limb revascularization, the optimal antithrombotic regimen for long-term management is unknown.

methodsThe EUCLID trial (Examining Use of Ticagrelor In PAD) randomized 13 885 patients with peripheral artery disease to treatment with ticagrelor 90 mg twice daily or clopidogrel 75 mg daily. Patients were enrolled based on an abnormal ankle-brachial index ≤0.80 or a previous lower extremity revascularization. This analysis focuses on the 7875 (57%) patients enrolled based on the previous lower extremity revascularization criterion. Patients could not be enrolled within 30 days of most recent revascularization, and patients with an indication for dual antiplatelet therapy were excluded. The primary efficacy end point was a composite of cardiovascular death, myocardial infarction, or ischemic stroke. The primary safety end point was major bleeding.

resultsPatients with a previous revascularization had a mean age of 66 years, 73% were male, and the median baseline ankle-brachial index was 0.78. After adjustment for baseline characteristics, patients enrolled based on previous revascularization had similar rates of the primary composite end point (hazard ratio [HR] 1.10, 95% confidence interval [CI] 0.98-1.23, P=0.12) and statistically significantly higher rates of myocardial infarction (HR 1.29, 95% CI 1.08-1.55, P=0.005) and acute limb ischemia (HR 4.23, 95% CI 2.86-6.25, P<0.001) when compared with patients enrolled based on ankle-brachial index criteria. No differences in ticagrelor- versus clopidogrel-treated patients were found for the primary efficacy end point (11.4% vs 11.3%; HR 1.01, 95% CI 0.88-1.15; P=0.90), all-cause mortality (9.2% vs 9.2%; HR 0.99, 95% CI 0.86-1.15; P=0.93), acute limb ischemia (2.5% vs 2.5%; HR 1.03, 95% CI 0.78-1.36; P=0.84), or major bleeding (1.9% vs 1.8%; HR 1.15, 95% CI 0.83-1.59; P=0.41). The median duration of follow-up was ≈30 months.

conclusionsAfter adjustment for baseline characteristics, patients enrolled based on previous revascularization for peripheral artery disease had higher rates of myocardial infarction and acute limb ischemia, with similar composite rates of cardiovascular death, myocardial infarction, and stroke when compared with patients enrolled based on the ankle-brachial index criterion. No significant differences were found between ticagrelor and clopidogrel for reduction of cardiovascular or acute limb events. CLINICAL

trial registrationURL: http://www.clinicaltrials.gov. Unique identifier: NCT01732822.

Indexed as

AdenosineAgedClopidogrelFemaleHumansLower ExtremityMalePeripheral Arterial DiseasePurinergic P2Y Receptor AntagonistsTicagrelorTiclopidineTreatment OutcomeAdenosineClopidogrelPurinergic P2Y Receptor AntagonistsTicagrelorTiclopidinelower extremity revascularizationperipheral artery diseaseticagrelorvascular intervention

Identifiers

PMID27840336

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