Abstract:
BACKGROUND:Guidelines suggest that "upstream" P2Y12 receptor antagonists should be considered in patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACS). HYPOTHESIS:Early use of ticagrelor in patients managed with an invasive strategy would be more effective than clopidogrel because of its more rapid onset of action and greater potency. METHODS:In the PLATO trial, 6792 NSTE-ACS patients were randomized to ticagrelor or clopidogrel (started prior to angiography) and underwent angiography within 72 hours of randomization. We compared efficacy and safety outcomes of ticagrelor vs clopidogrel as a function of "early" (<3h) vs "late" (≥3h) time to angiography. Adjusted Cox proportional hazards models evaluated interaction between randomized treatment and time from randomization to angiography on subsequent outcomes. RESULTS:Overall, a benefit of ticagrelor vs clopidogrel for cardiovascular death/myocardial infarction/stroke was seen at day 7 (hazard ratio [HR]: 0.67, P = 0.002), day 30 (HR: 0.81, P = 0.042), and 1 year (HR: 0.80, P = 0.0045). There were no significant interactions in the <3h vs ≥3h groups at any timepoint. For major bleeding, overall there was no significant increase (HR: 1.04, 95% confidence interval: 0.85-1.27); but there was a significant interaction with no difference between ticagrelor and clopidogrel in the early group (HR: 0.79), but higher bleeding risk with ticagrelor in the late angiography group, at 7 days (HR: 1.51, Pint = 0.002). Patterns were similar at 30 days and 1 year. CONCLUSIONS:The benefit of ticagrelor over clopidogrel was consistent in those undergoing early and late angiography, supporting upstream use of ticagrelor.
journal_name
Clin Cardioljournal_title
Clinical cardiologyauthors
Pollack CV Jr,Davoudi F,Diercks DB,Becker RC,James SK,Lim ST,Schulte PJ,Spinar J,Steg PG,Storey RF,Himmelmann A,Wallentin L,Cannon CP,PLATO Investigators.doi
10.1002/clc.22733subject
Has Abstractpub_date
2017-06-01 00:00:00pages
390-398issue
6eissn
0160-9289issn
1932-8737journal_volume
40pub_type
杂志文章,多中心研究,随机对照试验abstract::In 2002, coronary angiography is the only way to assess precisely the combination of proximal stenoses, distal target vessels, collaterals, microcirculation, and TIMI antegrade flow. At the time of coronary angiography, global LV function is best determined using biplane ventriculography in order to correlate wall mot...
journal_title:Clinical cardiology
pub_type: 社论
doi:10.1002/clc.4950250802
更新日期:2002-08-01 00:00:00
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journal_title:Clinical cardiology
pub_type: 杂志文章,随机对照试验
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abstract::It has been debated whether dilated cardiomyopathy seen in patients with acquired immune deficiency syndrome is caused by the virus itself or by the combination of other factors such as presence of opportunistic pathogens and/or severe immunosuppression. This paper describes the first reported case of a patient with h...
journal_title:Clinical cardiology
pub_type: 杂志文章
doi:10.1002/clc.4960200815
更新日期:1997-08-01 00:00:00
abstract:BACKGROUND:Sex-based differences in acute coronary syndrome (ACS) mortality may attenuate with age due to better symptom recognition and prompt care. HYPOTHESIS:Age is a modifier of temporal trends in sex-based differences in ACS care. METHODS:Among 104 817 eligible patients with ACS enrolled in the AHA Get With the ...
journal_title:Clinical cardiology
pub_type: 杂志文章,多中心研究
doi:10.1002/clc.22938
更新日期:2018-06-01 00:00:00
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journal_title:Clinical cardiology
pub_type: 杂志文章
doi:10.1002/clc.20231
更新日期:2007-10-01 00:00:00
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journal_title:Clinical cardiology
pub_type: 杂志文章
doi:10.1002/clc.4960061206
更新日期:1983-12-01 00:00:00
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journal_title:Clinical cardiology
pub_type: 杂志文章
doi:10.1002/clc.4960260412
更新日期:2003-04-01 00:00:00
abstract::The use of nisoldipine (10-20 mg b.i.d.) was evaluated as a replacement therapy for long-acting nifedipine (40-120 mg/day) in 21 patients with severe hypertension, who were resistant to or intolerant of nifedipine. Except for one patient with specific contraindications, all participants received an individually determ...
journal_title:Clinical cardiology
pub_type: 杂志文章
doi:10.1002/clc.4960110510
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journal_title:Clinical cardiology
pub_type: 杂志文章,评审
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journal_title:Clinical cardiology
pub_type: 杂志文章
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journal_title:Clinical cardiology
pub_type: 杂志文章
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journal_title:Clinical cardiology
pub_type: 杂志文章,meta分析
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pub_type: 杂志文章
doi:10.1002/clc.4960221304
更新日期:1999-01-01 00:00:00
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journal_title:Clinical cardiology
pub_type: 杂志文章,评审
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更新日期:2007-02-01 00:00:00
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journal_title:Clinical cardiology
pub_type: 临床试验,杂志文章
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更新日期:1997-01-01 00:00:00
abstract::In this editorial, I would like to share some thoughts about clinical studies, including value and limitations using as an example a recently published randomized clinical trial. Randomized and non-randomized clinical trials, epidemiologic studies, and registries guide our clinical practice. They are good but not perf...
journal_title:Clinical cardiology
pub_type: 社论
doi:10.1002/clc.20598
更新日期:2009-04-01 00:00:00
abstract::There is an apparent benefit with extension of dual antiplatelet therapy (DAPT) beyond 1 year after implantation of drug-eluting stents (DES). Assessment by a Double Randomization of a Conventional Antiplatelet Strategy vs a Monitoring-Guided Strategy for Drug-Eluting Stent Implantation, and of Treatment Interruption ...
journal_title:Clinical cardiology
pub_type: 杂志文章,多中心研究,随机对照试验
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更新日期:2016-04-01 00:00:00
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journal_title:Clinical cardiology
pub_type: 杂志文章
doi:10.1002/clc.4960220212
更新日期:1999-02-01 00:00:00
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journal_title:Clinical cardiology
pub_type: 杂志文章,评审
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journal_title:Clinical cardiology
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doi:10.1002/clc.4960221113
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pub_type: 杂志文章,多中心研究
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journal_title:Clinical cardiology
pub_type: 杂志文章
doi:10.1002/clc.4960150908
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pub_type: 杂志文章
doi:10.1002/clc.4960131209
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journal_title:Clinical cardiology
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doi:10.1002/clc.4960240411
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doi:10.1002/clc.4960110614
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journal_title:Clinical cardiology
pub_type: 杂志文章
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更新日期:2020-12-01 00:00:00
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journal_title:Clinical cardiology
pub_type: 杂志文章
doi:
更新日期:1988-03-01 00:00:00
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journal_title:Clinical cardiology
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更新日期:2015-05-01 00:00:00
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doi:10.1002/clc.4960110905
更新日期:1988-09-01 00:00:00