Ticagrelor in patients with acute coronary syndrome without ST elevation and a conservative treatment strategy

Abstract

The article provides an overview of the relevance of the use of dual antiplatelet therapy (DAT) in patients with acute coronary syndrome (ACS) without lifting ST (ACSwl ST ) receiving conservative treatment. Compared with those patients with ACSwl ST who underwent percutaneous coronary intervention, conservative treatment, patients traditionally have more comorbidities, risk factors and prognosis is worse. It is in this subgroup of patients to improve outcomes most important to carry out the most correct treatment of ACS, most strictly corresponding to current clinical guidelines. In particular this applies to that therapy, with which you can try to influence the mechanism of development of ACS, namely antirombocit therapy. The results of a clinical study PLATO showed that the use as a DAT combination with acetylsalicylic acid (ASA) and ticagrelor due to a decrease in the incidence of cardiovascular death, heart attack or stroke (primary adverse events) as compared to the combination of ASA and clopidogrel. The results of further analysis of PLATO study showed that when comparing the groups of patients with ACSwl ST treatment of invasive and conservative, noted a similar proportional reduction in the incidence of primary adverse events when using ticagrelor compared to clopidogrel group (hazard ratio of 0.86 compared with 0.85; p-value for interaction 0.89), which is consistent with the overall results of the study. Among patients with ACSwl ST treated conservatively, receiving ticagrelor as compared with clopidogrel was associated with a significantly smaller number of all deaths (relative risk, 0.73; 95 CI 0.57-0.93). The frequency of the "big" bleeding among patients treated conservatively with ACSwl ST treated with ticagrelor and clopidogrel did not differ significantly. PLATO study results identified the mandatory use of ticagrelor as DAT in patients with ACSwl ST regardless of the chosen treatment strategy.