Congratulations to Dr Patel and colleagues on a successful investigation into an important topic. I hope to have a productive discussion about the findings of the EUCLID trial and cardiovascular disease generally.
I found the lack of difference between clopidogrel and ticagrelor with respect to the primary endpoint surprising. The results of the CAPRIE, PLATO, PEGASUS, and other trials suggested that it was reasonable to expect some benefit from ticagrelor with respect to the endpoint of cardiovascular mortality, MI, or stroke.
How do we reconcile the results of these trials with those from EUCLID? How much can be ascribe to the exclusion of poor clopidogrel metabolizers? Is there something fundamentally different about patients who have principally symptomatic coronary atherosclerosis from those who have principally symptomatic peripheral atherosclerosis?
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