Guideline update on managing acute coronary syndrome

Acute Coronary Syndrome (ACS), more commonly known as heart attack, is an umbrella term for conditions that result from insufficient blood supply to the heart muscle. Different treatment strategies have been developed for ACS patients. However, the risk of death due to ACS remains high: Nearly one in six patients may die within the first year of their heart attack.

The American Heart Association (AHA) and the American College of Cardiology (ACC) in their latest guideline cited ticagrelor, an antiplatelet medication (P2Y12 inhibitor), as a preferred drug for patients with certain ACS. According to the guideline, ticagrelor is now preferred over clopidogrel for the management of “non-ST-elevation ACS” (NSTE-ACS) in patients who undergo an early invasive (angiography with intent for PCI if appropriate) or ischemia-guided strategy (i.e., medically managed), or those who receive a coronary stent. This is the first time AHA and ACC have recommended one P2Y12 over another in the treatment of ACS.

“We at AstraZeneca are very pleased with the latest development with the AHA/ACC guideline recognizing ticagrelor as the preferred drug over the current standard of care in the treatment of NSTE-ACS patients undergoing a broad range of treatment strategies,” said Gagan Singh, president of AstraZeneca Philippines.

“The inclusion and citation of ticagrelor as a preferred drug in the 2014 AHA/ACC guideline, reveals a renewed confidence in both the medicine and the PLATO data that support these new recommendations,” added Dr. Milagros Tan-Pineda, medical and regulatory affairs director of AstraZeneca Philippines.

This new guideline is based on a review of multiple clinical trials, including PLATO. PLATO was a large (18,624 patients in 43 countries) head-to-head patient outcomes study of ticagrelor versus clopidogrel, both given in combination with aspirin and other standard therapy, designed to establish whether ticagrelor plus aspirin could achieve a clinically meaningful reduction in cardiovascular (CV) events in ACS patients. Ticagrelor plus aspirin has been proven clinically superior to clopidogrel plus aspirin in reducing thrombotic CV events, including CV death, at 12 months, based on the results of the trial.

Ticagrelor belongs to a new class of oral antiplatelet treatment for ACS that works by preventing the formation of new blood clots and maintaining blood flow in the body to help reduce a patient’s risk of suffering another (potentially fatal) heart attack.

Ticagrelor is indicated to reduce the rate of thrombotic CV events in patients with ACS (unstable angina [UA], non–ST-elevation myocardial infarction [NSTEMI], or ST-elevation myocardial infarction [STEMI]). It has been shown to reduce the rate of a combined end point of CV death, myocardial infarction (MI) or stroke compared to clopidogrel. The difference between treatments was driven by CV death and MI with no difference in stroke. In patients treated with percutaneous coronary intervention (PCI), it also reduces the rate of stent thrombosis.

In total, ticagrelor is included in 12 major US and global ACS management guidelines and recognized in several of them as an important part of the standard of care in a broad range of invasively or noninvasively managed patients with ACS.

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