Prior smoking status, clinical outcomes, and the comparison of ticagrelor with clopidogrel in acute coronary syndromes-insights from the platelet inhibition and patient outcomes (plato) trial
American Heart Journal, 07/31/2012
Cornel JH et al. – In patients hospitalized with ACS, habitual smoking is associated with a greater risk of subsequent stent thrombosis. The reduction of vascular death, myocardial infarction, stroke, and stent thrombosis by ticagrelor compared to clopidogrel is consistent regardless of smoking habits.Methods
- Interactions between habitual smokers (n = 6678) and in ex/nonsmokers (n = 11,932) and the effects of randomized treatments on ischemic and bleeding outcomes were evaluated by Cox regression analyses.
- Habitual smokers had an overall lower risk profile and more often ST–elevation ACS.
- After adjustment for baseline imbalances, habitual smoking was associated with a higher incidence of definite stent thrombosis (adjusted HR, 1.44 [95% CI, 1.07–1.94]); there were no significant associations with other ischemic or bleeding end points.
- The effects of ticagrelor compared to clopidogrel were consistent for all outcomes regardless of smoking status.
- Thus, there was a similar reduction in the primary composite end point for habitual smokers (adjusted HR, 0.83 [95% CI, 0.68–1.00]) and ex/nonsmokers (adjusted HR, 0.89 [95% CI, 0.79–1.00]) (interaction P = .50), and in definite stent thrombosis for habitual smokers (adjusted HR, 0.59 [0.39–0.91]) and ex/nonsmokers (adjusted HR, 0.69 [95% CI, 0.45–1.07]) (interaction P = .61).