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Safety and efficacy of ticagrelor and clopidogrel in primary percutaneous coronary intervention
Matthijs A Velders1, Jérémie Abtan2, Dominick J Angiolillo3
1Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden.
Insights
Ticagrelor demonstrated comparable safety and efficacy to clopidogrel in ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI). Ticagrelor significantly reduced definite stent thrombosis in this STEMI subgroup.
Area of Science:
- Cardiology
- Interventional Cardiology
- Pharmacology
Background:
- The Platelet Inhibition and Patient Outcomes (PLATO) study evaluated ticagrelor versus clopidogrel.
- Previous findings showed ticagrelor's effectiveness in the overall PLATO population.
- This analysis focuses on ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI).
Purpose of the Study:
- To compare the efficacy and safety of ticagrelor versus clopidogrel in STEMI patients treated with primary PCI.
- To assess cardiovascular death, myocardial infarction, stroke, and bleeding events.
- To evaluate stent thrombosis rates in this specific patient subgroup.
Main Methods:
- A post-hoc subgroup analysis of 4949 PLATO patients with STEMI treated with primary PCI within 12 hours of admission.
- Comparison of ticagrelor and clopidogrel.
- Primary endpoint: composite of cardiovascular death, myocardial infarction, or stroke.
- Safety endpoint: any major bleeding.
- Secondary endpoint: stent thrombosis.
Main Results:
- No significant difference in the primary endpoint (7.9% vs 8.6%, p=0.38) or major bleeding (6.7% vs 6.8%, p=0.79) between ticagrelor and clopidogrel.
- Ticagrelor significantly reduced definite stent thrombosis (HR 0.58, p=0.013).
- Treatment effects were consistent with the overall PLATO trial, with no observed interactions for primary efficacy or safety endpoints.
Conclusions:
- Ticagrelor is a safe and effective alternative to clopidogrel in STEMI patients undergoing primary PCI.
- Ticagrelor demonstrated a significant reduction in definite stent thrombosis.
- Efficacy and safety outcomes align with the broader findings of the PLATO study.
Objective:
The effects of ticagrelor in the subpopulation of patients with ST-elevation myocardial infarction (STEMI) were consistent with those observed in the overall Platelet Inhibition and Patient Outcomes (PLATO) study. However, this subgroup included patients initially or ultimately treated conservatively. The aim of this study is to compare treatment using ticagrelor with treatment using clopidogrel in patients with STEMI undergoing primary percutaneous coronary intervention (PCI).
Methods:
This post-hoc subgroup analysis compared ticagrelor with clopidogrel in 4949 PLATO patients with STEMI that were treated with primary PCI within 12 h of admission. The primary endpoint was cardiovascular death, myocardial infarction or stroke. The safety endpoint consisted of any major bleeding. Secondary endpoints included stent thrombosis. The analysis was not adequately powered to establish significance of any treatment effects.
Results:
During a median of 286 days, the primary endpoint occurred in 7.9% of ticagrelor-treated patients versus 8.6% of clopidogrel-treated patients (HR 0.91, 95% CI 0.75 to 1.12, p=0.38). Major bleeding occurred in 6.7% in ticagrelor-treated patients versus 6.8% of clopidogrel-treated patients (HR 0.97, 95% CI 0.77 to 1.22, p=0.79). No interactions were observed for the treatment effect of ticagrelor versus clopidogrel on the primary efficacy (p=0.40) and primary safety endpoints (p=0.15) as compared with the full PLATO population. Treatment with ticagrelor versus clopidogrel reduced the occurrence of definite stent thrombosis (HR 0.58, 95% CI 0.37 to 0.89, p=0.013).
Conclusions:
In the subset of patients with STEMI treated with primary PCI, ticagrelor compared with clopidogrel was safe, and efficacy outcomes were consistent with the overall PLATO trial.
Trial Registration Number:
NCT00391872; Results.
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