Randomized Comparison of Clopidogrel Versus Ticagrelor or Prasugrel ...


Randomized Comparison of Clopidogrel Versus Ticagrelor or Prasugrel in Patients of 70 years or Older With Non-ST-Elevation Acute Coronary Syndrome - POPular AGE

Author/Summarized by Author:Anthony A. Bavry, MD, MPH, FACC

Description:

The goal of the trial was to evaluate clopidogrel compared with ticagrelor or prasugrel among patients ≥70 years of age being treated for a non-ST-segment elevation acute coronary syndrome (NSTE-ACS).

Study Design

  • Randomized
  • Parallel
  • Open-label

Patients ≥70 years of age with an NSTE-ACS were randomized to clopidogrel (n = 501) versus ticagrelor or prasugrel (n = 502) for 12 months.

  • Total number of enrollees: 1,003
  • Duration of follow-up: 12 months
  • Mean patient age: 77 years
  • Percentage female: 37%
  • Percentage with diabetes: 29%

Inclusion criteria:

  • Patients ≥70 years of age with an NSTE-ACS

Exclusion criteria:

  • Contraindication to a P2Y12 inhibitor
  • Dual antiplatelet therapy use prior to presentation
  • Indication for major surgery
  • Limited life expectancy (<1 year)

Principal Findings:

The co-primary safety outcome of PLATO major and minor bleeding occurred in 17.6% of the clopidogrel group compared with 23.1% of the ticagrelor/prasugrel group (p = 0.03).

The co-primary net clinical benefit outcome of death, myocardial infarction, stroke, or PLATO major and minor bleeding occurred in 27.3% of the clopidogrel group compared with 30.7% of the ticagrelor/prasugrel group (p for noninferiority = 0.06).

Secondary outcomes:

  • PLATO major bleeding: 4.4% of the clopidogrel group compared with 8.0% of the ticagrelor/prasugrel group (p = 0.02)
  • Fatal bleeding: 0% of the clopidogrel group compared with 1.0% of the ticagrelor/prasugrel group (p = 0.03)
  • Death, myocardial infarction, or stroke: 12.8% of the clopidogrel group compared with 12.5% of the ticagrelor/prasugrel group (p = 0.91)
  • Adherence: 76% in the clopidogrel group vs. 51% in the ticagrelor/prasugrel group

References:

Presented by Dr. Marieke E. Gimbel at the European Society of Cardiology Congress, Paris, France, August 31, 2019