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J Am Coll Cardiol. 2019 Mar 12. pii: S0735-1097(19)33879-3. doi: 10.1016/j.jacc.2019.03.011. [Epub ahead of print]

Ticagrelor versus Clopidogrel in Patients with STEMI Treated with Fibrinolytic Therapy: TREAT Trial.

Author information

1
Research Institute - Heart Hospital (HCor) - São Paulo, Brazil. Electronic address: otavioberwanger@gmail.com.
2
Duke Clinical Research Institute - Durham, United States; Universidade Federal de São Paulo - São Paulo, Brazil.
3
Research Institute - Heart Hospital (HCor) - São Paulo, Brazil.
4
Universidade Federal de São Paulo - São Paulo, Brazil.
5
Fuwai Hospital - Beijing, China.
6
Canadian Heart Research Centre (CHRC) and Division of Cardiology, St. Michael's Hospital, University of Toronto - Toronto, Canada.
7
Monash Cardiovascular Research Centre, Monash University, Melbourne, Australia.
8
Institute of Cardiology - Emergency Cardiology Department - Kiev, Ukraine.
9
Pirogov Russian National Research Medical University - Moscow, Russia.
10
Hospital de Alta Complejidad El Cruce - Buenos Aires, Argentina.
11
School of Medicine, Universidad Peruana Cayetano Heredia - Lima, Peru.
12
Hospital e Maternidade Celso Pierro - Campinas, Brazil.
13
Heart Hospital (HCor) - São Paulo, Brazil.
14
Duke Clinical Research Institute - Durham, United States.
15
Auckland City Hospital - Auckland District Health Board - Auckland, New Zealand.
16
Instituto do Coração (InCor) - Hospital das Clinicas HCFMUSP - Faculdade de Medicina - Universidade de São Paulo - São Paulo, Brazil.

Abstract

BACKGROUND:

The efficacy of ticagrelor in the long-term post ST-elevation myocardial infarction (STEMI) treated with fibrinolytic therapy remains uncertain.

OBJECTIVES:

To evaluate the efficacy of ticagrelor when compared with clopidogrel in STEMI patients treated with fibrinolytic therapy.

METHODS:

We conducted an international, multicenter, randomized, open-label with blinded endpoint adjudication trial that enrolled 3,799 patients (age < 75 years) with STEMI receiving fibrinolytic therapy. Patients were randomized to ticagrelor (180-mg loading dose, 90 mg twice daily thereafter) or clopidogrel (300-to-600-mg loading dose, 75 mg daily thereafter The key outcomes were cardiovascular mortality, myocardial infarction, or stroke, and the same composite outcome with the addition of severe recurrent ischemia, transient ischemic attack, or other arterial thrombotic events at 12 months.

RESULTS:

The combined outcome of cardiovascular mortality, myocardial infarction or stroke occurred in 129 of 1,913 patients (6.7%) receiving ticagrelor and in 137 of 1,886 patients (7.3%) receiving clopidogrel (hazard ratio of 0.93; 95% CI, 0.73 to 1.18; P=0.53). The composite of cardiovascular mortality, myocardial infarction, stroke, severe recurrent ischemia, transient ischemic attack, or other arterial thrombotic events occurred in 153 of 1,913 patients (8.0%) treated with ticagrelor and in 171 of 1,886 patients (9.1%) receiving clopidogrel (hazard ratio of 0.88; 95% CI, 0.71 to 1.09; P=0.25). The rates of major, fatal, and intracranial bleeding were similar between the ticagrelor and clopidogrel groups.

CONCLUSIONS:

Among patients aged under 75 years with STEMI, administration of ticagrelor after fibrinolytic therapy did not significantly reduce the frequency of cardiovascular events when compared with clopidogrel.

KEYWORDS:

Blinded Adjudication; Dual antiplatelet therapy; Fibrinolysis; Myocardial Infarction; STEMI; Ticagrelor

PMID:
30898608
DOI:
10.1016/j.jacc.2019.03.011

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