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Circulation. 2014 Jan 21;129(3):293-303. doi: 10.1161/CIRCULATIONAHA.113.004420. Epub 2013 Oct 29.

Biomarkers in relation to the effects of ticagrelor in comparison with clopidogrel in non-ST-elevation acute coronary syndrome patients managed with or without in-hospital revascularization: a substudy from the Prospective Randomized Platelet Inhibition and Patient Outcomes (PLATO) trial.

Author information

1
Department of Medical Sciences, Cardiology and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden (L.W., D.L., L.W., C.H., S.K.J.); Department of Medical Sciences, Clinical Chemistry and Uppsala Clinical Research Center Uppsala University, Uppsala, Sweden (A.S.); Division of Cardiovascular Health and Disease, Heart, Lung and Vascular Institute, Academic Health Center, Cincinnati, OH (R.C.B.); Department of Medicine, Stanford University, Stanford, CA (R.A.H., K.W.M.); TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (C.P.C.); Department of Cardiology, Medisch Centrum Alkmaar, Alkmaar, Netherlands (J.H.C.); AstraZeneca Research and Development, Mölndal, Sweden (A.H.); Medizinische Klinik, Universitätsklinikum Heidelberg, Heidelberg, Germany (E.G., H.A.K.); Medical Department, Hospital Unit West, Herning/Holstbro, Denmark (S.H.); INSERM-Unité 698, Paris, France; Assistance Publique-Hôpitaux de Paris, Département Hospitalo-Universitaire FIRE, Hôpital Bichat, Paris, France; Université Paris-Diderot, Sorbonne-Paris Cité, Paris, France; NHLI Imperial College, ICMS, Royal Brompton Hospital, London, UK (P.G.S.); and Department of Cardiovascular Science, University of Sheffield, Sheffield, UK (R.F.S.).

Abstract

BACKGROUND:

Risk stratification and the use of specific biomarkers have been proposed for tailoring treatment in patients with non-ST-elevation acute coronary syndrome (NSTE-ACS). We investigated the prognostic importance of high-sensitivity troponin T (hs-TnT), N-terminal pro-brain natriuretic peptide (NT-proBNP), and growth differentiation factor-15 (GDF-15) in relation to randomized treatment (ticagrelor versus clopidogrel) and management strategy (with or without revascularization) in the NSTE-ACS subgroup of the Platelet Inhibition and Patient Outcomes (PLATO) trial.

METHODS AND RESULTS:

Of 18 624 patients in the PLATO trial, 9946 had an entry diagnosis of NSTE-ACS and baseline blood samples available. During index hospitalization, 5357 were revascularized, and 4589 were managed without revascularization. Hs-TnT, NT-proBNP, and GDF-15 were determined and assessed according to predefined cutoff levels. Median follow-up was 9.1 months. Increasing levels of hs-TnT were associated with increasing risk of cardiovascular death, myocardial infarction, and stroke in medically managed patients (P<0.001), but not in those managed invasively. NT-proBNP and GDF-15 levels were associated with the same events independent of management strategy. Ticagrelor versus clopidogrel reduced the rate of cardiovascular death, myocardial infarction, and stroke in patients with NSTE-ACS and hs-TnT ≥14.0 ng/L in both invasively and noninvasively managed patients; in patients with hs-TnT <14.0 ng/L, there was no difference between ticagrelor and clopidogrel in the noninvasive group

CONCLUSIONS:

Hs-TnT, NT-proBNP, and GDF-15 are predictors of cardiovascular death, myocardial infarction, and stroke in patients with NSTE-ACS managed noninvasively, and NT-proBNP and GDF-15 also in those managed invasively. Elevated hs-TnT predicts substantial benefit of ticagrelor over clopidogrel both in invasively and noninvasively managed patients, but no apparent benefit was seen at normal hs-TnT.

CLINICAL TRIAL REGISTRATION:

URL:http://www.clinicaltrials.gov. Unique identifier: NCT00391872.

KEYWORDS:

acute coronary syndrome; biological markers; blood platelets; myocardial infarction; troponin

[Indexed for MEDLINE]

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