Please select the arm or intervention descriptions that belong to the clinical trial below.
Title: TicagRelor Or Clopidogrel in Severe and Terminal Chronic Kidney Disease Patients Undergoing PERcutaneous Coronary Intervention for an Acute Coronary Syndrome.
Brief Summary: Ticagrelor is a potent and fast-acting P2Y12-ADP receptor antagonist recommended as first-line agent in ACS (2). This drug was associated with a 20% relative reduction in the rate of MACE in ACS patients undergoing PCI compared to clopidogrel. This benefit came without any increase in major bleedings compared to clopidogrel (6).

In the PLATO trial, a limited number of kidney failure patients were included (21%) and patients with terminal CKD were excluded. A sub-group analysis focused on CKD patients was performed. Only 214 patients with CKD below stage 4 (creatinine clearance \<30 ml/min) were included (7). No patient with terminal CKD or undergoing chronic hemodialysis was included.

Of importance, kidney function impairment is frequent and affects up-to 40 % of ACS patients. In addition, CKD is a powerful independent predictor of ischemic complications during ACS (8-9).Indeed, CKD patients have a very high risk of MACE following ACS with an odd ratio between 2 and 3 compared to patients with normal kidney function and event rates above 40% at one year follow-up (8-13). Of importance these patients more often have high on-clopidogrel platelet reactivity which was strongly associated with a worse clinical outcome (3,14-16). In CKD patients HTPR was associated with death after PCI (15). Accordingly ticagrelor which overcomes these limitations of clopidogrel could be associated with a major clinical benefit in severe or terminal CKD patients.

Most of ticagrelor and is active metabolites are excreted through the feces. Preclinical data suggested that renal impairment had little effect on systemic exposure to the drug(EMEA/H/C/1241 (28)). Recent pharmacodynamic and kinetic studies confirmed these preclinical data on the safety of ticagrelor in severe and end-stage CKD (17-19).

Therefore based on the rational above and to the lack of relevant clinical data, the optimal P2Y12-ADP receptor antagonist for patients with stage 4 and 5 and patients undergoing chronic dialysis remains undetermined in ACS treated with PCI.

We aimed to compare the clinical efficacy ticagrelor and clopidogrel in patients with stage 4 and 5 or on chronic hemodialysis undergoing PCI for ACS.


Options:
A: Arm Label: Prasugrel; Type: EXPERIMENTAL; Interventions: Drug: Prasugrel | Arm Label: Clopidogrel; Type: ACTIVE_COMPARATOR; Interventions: Drug: Clopidogrel | Intervention Type: DRUG; Name: Prasugrel; Assigned to Arm(s): Prasugrel | Intervention Type: DRUG; Name: Clopidogrel; Assigned to Arm(s): Clopidogrel
B: Arm Label: Clopidogrel group; Type: EXPERIMENTAL; Interventions: Drug: Clopidogrel | Arm Label: Ticagrelor group; Type: EXPERIMENTAL; Interventions: Drug: Ticagrelor | Intervention Type: DRUG; Name: Clopidogrel; Assigned to Arm(s): Clopidogrel group | Intervention Type: DRUG; Name: Ticagrelor; Assigned to Arm(s): Ticagrelor group
C: Arm Label: Combination Clopidogrel and asprin; Type: ACTIVE_COMPARATOR; Interventions: Drug: Clopidogrel | Arm Label: Asprin and placebo; Type: PLACEBO_COMPARATOR; Interventions: Drug: Placebo of clopidogrel and Asprin | Intervention Type: DRUG; Name: Clopidogrel; Assigned to Arm(s): Combination Clopidogrel and asprin | Intervention Type: DRUG; Name: Placebo of clopidogrel and Asprin; Assigned to Arm(s): Asprin and placebo
D: Arm Label: Standard Treatment Arm; Type: ACTIVE_COMPARATOR; Interventions: Behavioral: Diet, Behavioral: Exercise, Behavioral: Stop smoking, Drug: Glucose lowering therapy, Drug: Blood pressure lowering therapy, Drug: Lipid lowering therapy | Arm Label: Intensive Treatment Arm; Type: EXPERIMENTAL; Interventions: Behavioral: Diet, Behavioral: Exercise, Behavioral: Stop smoking, Drug: Glucose lowering therapy, Drug: Blood pressure lowering therapy, Drug: Lipid lowering therapy | Intervention Type: BEHAVIORAL; Name: Diet; Assigned to Arm(s): Intensive Treatment Arm, Standard Treatment Arm | Intervention Type: BEHAVIORAL; Name: Exercise; Assigned to Arm(s): Intensive Treatment Arm, Standard Treatment Arm | Intervention Type: BEHAVIORAL; Name: Stop smoking; Assigned to Arm(s): Intensive Treatment Arm, Standard Treatment Arm | Intervention Type: DRUG; Name: Glucose lowering therapy; Assigned to Arm(s): Intensive Treatment Arm, Standard Treatment Arm | Intervention Type: DRUG; Name: Blood pressure lowering therapy; Assigned to Arm(s): Intensive Treatment Arm, Standard Treatment Arm | Intervention Type: DRUG; Name: Lipid lowering therapy; Assigned to Arm(s): Intensive Treatment Arm, Standard Treatment Arm

Answer: B