Related Experiment Video
Updated: Jul 3, 2025
Microfluidics in Assessing Platelet Function
Published on: November 8, 2024
Ticagrelor vs Clopidogrel for Complex Percutaneous Coronary Intervention in Chronic Coronary Syndrome
Benoit Lattuca1, Cedric Mazeau2, Guillaume Cayla1
1Sorbonne Université, ACTION Study Group, INSERM UMRS1166, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France; Cardiology Department, Nîmes University Hospital, Montpellier University, ACTION Study Group, Nîmes, France.
Insights
Complex percutaneous coronary intervention (PCI) in chronic coronary syndrome patients leads to more cardiovascular events. Ticagrelor did not reduce these events compared to clopidogrel in the ALPHEUS trial.
Area of Science:
- Cardiology
- Interventional Cardiology
- Pharmacology
Background:
- The efficacy of ticagrelor in preventing cardiovascular events in chronic coronary syndrome patients undergoing complex percutaneous coronary intervention (PCI) remains unclear.
- Complex PCI procedures present unique challenges and risks for patients with chronic coronary syndrome.
Purpose of the Study:
- To evaluate the outcomes of complex PCI in patients with chronic coronary syndrome.
- To compare the efficacy of ticagrelor versus clopidogrel in stable patients undergoing complex PCI within the ALPHEUS trial.
Main Methods:
- Complex PCI was defined by specific criteria including stent length, bifurcation stenting, left main intervention, bypass graft stenting, chronic total occlusion, atherectomy, guiding catheter extension use, multiwire technique, or multiple stents.
- The primary endpoint was a composite of type 4a or b myocardial infarction (MI) and major myocardial injury within 48 hours post-PCI.
- Event rates were compared between complex and non-complex PCI groups, with an analysis of treatment interaction between PCI complexity and ticagrelor or clopidogrel.
Main Results:
- Nearly half (48.3%) of the 1,866 randomized patients underwent complex PCI.
- Complex PCI was associated with significantly higher rates of the primary endpoint (45.6% vs 26.6%), driven by increased type 4 MI and angiographic complications.
- Higher rates of composite death, MI, and stroke were observed at 48 hours and 30 days in the complex PCI group.
- No significant interaction was found between PCI complexity and the choice of ticagrelor or clopidogrel for primary or secondary endpoints.
Conclusions:
- Patients with chronic coronary syndrome undergoing complex PCI experience elevated rates of periprocedural and cardiovascular events.
- Ticagrelor did not demonstrate a significant benefit over clopidogrel in reducing these events in the context of complex PCI.
- The findings suggest that PCI complexity is a significant risk factor, irrespective of the P2Y12 inhibitor used.
Background:
Whether ticagrelor in chronic coronary syndrome patients undergoing complex percutaneous coronary intervention (PCI) can prevent cardiovascular events is unknown.
Objectives:
The authors sought to evaluate outcomes of complex PCI and the efficacy of ticagrelor vs clopidogrel in stable patients randomized in the ALPHEUS (Assessment of Loading with the P2Y12 inhibitor ticagrelor or clopidogrel to Halt ischemic Events in patients Undergoing elective coronary Stenting) trial.
Methods:
All PCI procedures were blindly reviewed and classified as complex if they had at least 1 of the following criteria: stent length >60 mm, 2-stent bifurcation, left main, bypass graft, chronic total occlusion, use of atherectomy or guiding catheter extensions, multiwire technique, multiple stents. The primary endpoint was a composite of type 4a or b myocardial infarction (MI) and major myocardial injury during the 48 hours after PCI. We compared the event rates according to the presence or not of complex PCI criteria and evaluated the interaction with ticagrelor or clopidogrel.
Results:
Among the 1,866 patients randomized, 910 PCI (48.3%) were classified as complex PCI. The primary endpoint was more frequent in complex PCI (45.6% vs 26.6%; P < 0.001) driven by higher rates of type 4 MI and angiographic complications (12.2% vs 4.8 %; P < 0.001 and 19.3% vs 8.6%; P < 0.05, respectively). The composite of death, MI, and stroke at 48 hours (12.7% vs 5.1 %; P < 0.05) and at 30 days (13.4% vs 5.3%; P < 0.05) was more frequent in complex PCI. No interaction was found between PCI complexity and the randomized treatment for the primary endpoint (Pinteraction = 0.47) nor the secondary endpoints.
Conclusions:
In chronic coronary syndrome, patients undergoing a complex PCI have higher rates of periprocedural and cardiovascular events that are not reduced by ticagrelor as compared with clopidogrel.
More Related Videos
10:28Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
Published on: March 15, 2022
18:11A Research Method For Detecting Transient Myocardial Ischemia In Patients With Suspected Acute Coronary Syndrome Using Continuous ST-segment Analysis
Published on: December 28, 2012
Related Concept Videos
01:20Antiplatelet Drugs: Prostaglandin Synthesis, P2Y12 and Glycoprotein IIb/IIIa Inhibitors
Prostaglandin synthesis inhibitors, exemplified by the widely known aspirin, wield their power by irreversibly acetylating...
01:18Anticoagulant Drugs: Vitamin K Antagonists and Direct Oral Anticoagulants
Warfarin, a prominent vitamin K antagonist family member, exerts its effect by inhibiting the enzyme VKORC1 (vitamin K epoxide reductase complex 1). By hindering this enzyme, warfarin...
01:25Antianginal Drugs: Calcium Channel Blockers and Ranolazine
CCBs, a diverse class that includes dihydropyridines (nifedipine) and diphenylalkylamines (verapamil and diltiazem), exert their effect by blocking calcium channels in cardiac and smooth muscle cells. This...
01:23Treatment for Pulmonary Arterial Hypertension: Prostacyclin Receptor Agonists
These agonists bind to the IPR receptor situated on the plasma membrane of the pulmonary artery smooth muscle cells. This binding triggers a cascade of reactions known as the GS-AC-cAMP-PKA pathway. This pathway results in the relaxation of smooth muscle...
01:26Treatment for Pulmonary Arterial Hypertension: Receptor Tyrosine Kinase Inhibitors and Calcium Channel Blockers
TKIs, such as imatinib (Gleevec), are particularly effective in tackling the growth and mitogenic factors that become upregulated in PAH patients. These factors contribute to the...