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PRIOR SMOKING STATUS, CLINICAL OUTCOMES, AND THE COMPARISON OF TICAGRELOR WITH CLOPIDOGREL IN ACUTE CORONARY SYNDROMES – INSIGHTS FROM THE PLATELET INHIBITION AND PATIENT OUTCOMES (PLATO) TRIAL
E495 JACC March 27, 2012 Volume 59, Issue 13
Acute Coronary Syndromes PRIOR SMOKING STATUS, CLINICAL OUTCOMES, AND THE COMPARISON OF TICAGRELOR WITH CLOPIDOGREL IN ACUTE CORONARY SYNDROMES - INSIGHTS FROM THE PLATELET INHIBITION AND PATIENT OUTCOMES (PLATO) TRIAL ACC Moderated Poster Contributions McCormick Place South, Hall A Sunday, March 25, 2012, 11:00 a.m.-Noon
Session Title: Acute Coronary Syndromes: Clinical VII Abstract Category: 5. Acute Coronary Syndromes: Clinical Presentation Number: 1162-641 Authors: Jan Hein Cornel, Richard Becker, Shaun Goodman, Steen Husted, Hugo Katus, Anwar Santoso, Philippe Steg, Robert Storey, Marius Vintila, jie sun, Jay Horrow, Lars Wallentin, Robert Harrington, Stefan James, PLATO Study Group, Medisch Centrum Alkmaar, Alkmaar, The Netherlands Background: Habitual smoking has been associated with increased platelet reactivity, increased risk of thrombotic complications and greater efficacy of clopidogrel therapy over placebo. In the PLATO trial, ticagrelor compared to clopidogrel in patients with acute coronary syndromes (ACS) reduced the primary composite endpoint of vascular death, myocardial infarction and stroke, without increasing overall rates of major bleeding. Methods: Smoking status was known in 18610 of the 18624 patients randomized. We investigated ischemic and bleeding outcomes of ticagrelor versus clopidogrel in habitual smokers (N=6678) and in ex/non smokers (N=11,932). Results: Habitual smokers had an overall lower risk profile and more often ST elevation ACS. After adjustment for baseline differences, habitual smoking was associated with a higher incidence of definite stent thrombosis (adjusted HR 1.44 [95%CI 1.07-1.94]); there were no significant associations with other ischemic or bleeding endpoints. The effects of ticagrelor compared to clopidogrel were consistent regardless of smoking status (figure). There was no interaction between smoking status and the effects of treatment. Conclusions: In ACS patients, prior habitual smoking is associated with a greater risk of subsequent stent thrombosis. The reduction of vascular death, myocardial infarction, stroke and stent thrombosis by ticagrelor compared to clopidogrel is consistent regardless of smoking habits.
Acute Coronary Syndromes PRIOR SMOKING STATUS, CLINICAL OUTCOMES, AND THE COMPARISON OF TICAGRELOR WITH CLOPIDOGREL IN ACUTE CORONARY SYNDROMES - INSIGHTS FROM THE PLATELET INHIBITION AND PATIENT OUTCOMES (PLATO) TRIAL ACC Moderated Poster Contributions McCormick Place South, Hall A Sunday, March 25, 2012, 11:00 a.m.-Noon
Session Title: Acute Coronary Syndromes: Clinical VII Abstract Category: 5. Acute Coronary Syndromes: Clinical Presentation Number: 1162-641 Authors: Jan Hein Cornel, Richard Becker, Shaun Goodman, Steen Husted, Hugo Katus, Anwar Santoso, Philippe Steg, Robert Storey, Marius Vintila, jie sun, Jay Horrow, Lars Wallentin, Robert Harrington, Stefan James, PLATO Study Group, Medisch Centrum Alkmaar, Alkmaar, The Netherlands Background: Habitual smoking has been associated with increased platelet reactivity, increased risk of thrombotic complications and greater efficacy of clopidogrel therapy over placebo. In the PLATO trial, ticagrelor compared to clopidogrel in patients with acute coronary syndromes (ACS) reduced the primary composite endpoint of vascular death, myocardial infarction and stroke, without increasing overall rates of major bleeding. Methods: Smoking status was known in 18610 of the 18624 patients randomized. We investigated ischemic and bleeding outcomes of ticagrelor versus clopidogrel in habitual smokers (N=6678) and in ex/non smokers (N=11,932). Results: Habitual smokers had an overall lower risk profile and more often ST elevation ACS. After adjustment for baseline differences, habitual smoking was associated with a higher incidence of definite stent thrombosis (adjusted HR 1.44 [95%CI 1.07-1.94]); there were no significant associations with other ischemic or bleeding endpoints. The effects of ticagrelor compared to clopidogrel were consistent regardless of smoking status (figure). There was no interaction between smoking status and the effects of treatment. Conclusions: In ACS patients, prior habitual smoking is associated with a greater risk of subsequent stent thrombosis. The reduction of vascular death, myocardial infarction, stroke and stent thrombosis by ticagrelor compared to clopidogrel is consistent regardless of smoking habits.