Ticagrelor Compared With Clopidogrel in Patients With Prior Lower Extremity Revascularization for Peripheral Artery Disease

Jones, WS; Baumgartner, I; Hiatt, WR; Heizer, G; Conte, MS; White, CJ; Berger, JS; Held, P; Katona, BG; Mahaffey, KW; Norgren, L; Blomster, J; Millegård, M; Reist, C; Patel, MR; Fowkes, FG; International Steering Committee and Investigators of the EUCLID Trial

doi:10.1161/circulationaha.116.025880

Aortic & peripheral vascular disease

Ticagrelor Compared With Clopidogrel in Patients With Prior Lower Extremity Revascularization for Peripheral Artery Disease

CirculationPublished 13 Nov 2016Secondary analysis of the EUCLID randomised trial

Primary resultResultHazard ratio 1.01 95% CI 0.88–1.15

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Authors' conclusion

No significant differences were found between ticagrelor and clopidogrel for reduction of cardiovascular or acute limb events.

Study context

Population: Patients with PAD enrolled in EUCLID on the basis of previous lower extremity revascularization; no enrolment within 30 days of most recent revascularization; patients with an indication for DAPT excluded57% of 13,885 randomized
Participants: 7,875 patients

Comparison: Ticagrelor vs Clopidogrel
Primary endpoint: Composite of:
CV death
MI
Ischemic stroke
Follow-up: Median ≈30 months

Primary result

As reported in the abstract

Hazard ratio

1.01

95% CI 0.88–1.15

P = 0.90

By group

Ticagrelor11.4%

Clopidogrel11.3%

Ticagrelor vs Clopidogrel

HR 1.01 (95% CI 0.88–1.15); P = 0.90

Further findings

Outcome	Ticagrelor	Clopidogrel	← Lower risk ←→ Higher risk →	HR (95% CI)	P value
All-cause mortality	9.2%	9.2%	0.10.31310	0.99 (0.86–1.15)	P = 0.93
Acute limb ischemia	2.5%	2.5%	0.10.31310	1.03 (0.78–1.36)	P = 0.84
Enrolled based on previous revascularization vs ankle-brachial index criteria (adjusted)Previous revascularization vs Ankle-brachial index criteria · primary composite end point · After adjustment for baseline characteristics			0.10.31310	1.10 (0.98–1.23)	P = 0.12
Enrolled based on previous revascularization vs ankle-brachial index criteria (adjusted)Previous revascularization vs Ankle-brachial index criteria · MI · After adjustment for baseline characteristics			0.10.31310	1.29 (1.08–1.55)	P = 0.005
Enrolled based on previous revascularization vs ankle-brachial index criteria (adjusted)Previous revascularization vs Ankle-brachial index criteria · acute limb ischemia · After adjustment for baseline characteristics			0.10.31310	4.23 (2.86–6.25)	P < 0.001
			0.10.31310Hazard ratio (log scale)

Safety

Outcome	Ticagrelor	Clopidogrel	← Lower risk with ticagrelor ←→ Higher risk with ticagrelor →	HR (95% CI)	P value
Major bleeding (primary safety end point)	1.9%	1.8%	0.512	1.15 (0.83–1.59)	P = 0.41
			0.512Hazard ratio (log scale)

Original publication

Ticagrelor Compared With Clopidogrel in Patients With Prior Lower Extremity Revascularization for Peripheral Artery Disease. Circulation. Published 13 November 2016. doi:10.1161/circulationaha.116.025880

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Summarised from the published abstract; every number is checked against it