Título original: Angiographic Outcomes in the PLATO Trial (Platelet Inhibition and Patient Outcomes). Referencia: Vijay Kunadian et al. J Am Coll Cardiol Intv 2013;6:671–83.
In the PLATO (Platelet Inhibition and Patient Outcomes) trial, treatment with ticagrelor compared with clopidogrel resulted in a significant reduction in the combined endpoint of cardiac death, heart attack or stroke in patients undergoing an acute coronary syndrome. Ticagrelor inhibits activation and platelet aggregation by blocking selective and reversible P2Y12 receptor. The mechanism of this clinical benefit would be a more potent and predictable antiplatelet so that this trial hypothesis is that ticagrelor compared with clopidogrel will improve angiographic end points of coronary flow and myocardial perfusion before and after angioplasty.
In this angiographic substudy of PLATO trial, 2068 patents were analyzed experiencing an acute coronary syndrome both with ST segment elevation (55.8% of the population) and no elevation (non ST infarct 34.6% and unstable angina 8.7%). After angioplasty a myocardial perfusion grade 3 was obtained, identical between the two branches (ticagrelor 47.1% versus clopidogrel 46.9%, P = .96). The results were similar when patients were analyzed separately, those admitted with ST-segment elevation (42.4% versus 40.9%, p = 0.65) or without elevation (54% versus 55.9%, P = .64). Epicardial flow TIMI 3 was achieved in 88.1% of patients receiving ticagrelor versus 88.4% in those receiving clopidogrel (p = 0.28).
Conclusion:
No differences were observed neither on the epicardial coronary flow not myocardial perfusion between patients receiving ticagrelor and those who received clopidogrel both before and after angioplasty.
Commentary:
The benefit observed with glycoprotein inhibitors IIBIIIA in other works in terms of TIMI flow and myocardial perfusion before and after angioplasty was the point that made assuming that ticagrelor could show the same benefit given its anti-aggregating and more powerful effect. While the above might be true, so is that ticagrelor shares with clopidogrel oral administration and a single agonist blockade.
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