Mechanisms Potentially Contributing to the Reduction in Mortality Associated With Ticagrelor Therapy

In this issue of the Journal, Held et al. (1) report the outcomes of patients who underwent coronary artery bypass graft surgery (CABG) after being randomly assigned to clopidogrel or ticagrelor in the PLATO (Platelet Inhibition and Patient Outcomes) trial. The primary finding of reduced cardiovascular and total mortality among patients who had CABG and were treated with ticagrelor was directionally consistent but substantially greater (more than 2-fold) compared with that of the parent study (1,2). Elucidation of the mechanisms contributing to the greater reduction in mortality in patients who had CABG and were treated with ticagrelor should advance our understanding of the role of antiplatelet therapy for patients with acute coronary syndromes. Because the magnitude of reduction in mortality was substantially greater and statistically significant for cardiovascular mortality, this comment will focus on potential mechanisms related to cardiovascular outcomes.