Ticagrelor Versus Clopidogrel in Patients With STEMI Treated With Fibrinolysis: TREAT Trial |
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| Authors: | Otavio Berwanger Renato D. Lopes Diogo D.F. Moia Francisco A. Fonseca Lixin Jiang Shaun G. Goodman Stephen J. Nicholls Alexander Parkhomenko Oleg Averkov Carlos Tajer Germán Malaga Jose F.K. Saraiva Helio P. Guimaraes Pedro G.M. de Barros e Silva Lucas P. Damiani Renato H.N. Santos Denise M. Paisani Tamiris A. Miranda Jose C. Nicolau |
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| Affiliation: | 1. Research Institute, Heart Hospital (HCor), São Paulo, Brazil;2. Duke Clinical Research Institute, Durham, North Carolina;3. Universidade Federal de São Paulo, São Paulo, Brazil;4. Fuwai Hospital, Beijing, China;5. Canadian Heart Research Centre (CHRC) and Division of Cardiology, St. Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada;6. Monash Cardiovascular Research Centre, Monash University, Melbourne, Victoria, Australia;7. Institute of Cardiology, Emergency Cardiology Department, Kiev, Ukraine;8. Pirogov Russian National Research Medical University, Moscow, Russia;9. Hospital de Alta Complejidad El Cruce, Buenos Aires, Argentina;10. School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru;11. Hospital e Maternidade Celso Pierro, Campinas, Brazil;12. Heart Hospital (HCor), São Paulo, Brazil;13. Auckland City Hospital, Auckland District Health Board, Auckland, New Zealand;14. Instituto do Coração (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil |
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| Abstract: | BackgroundThe efficacy of ticagrelor in the long-term post–ST-segment elevation myocardial infarction (STEMI) treated with fibrinolytic therapy remains uncertain.ObjectivesThe purpose of this study was to evaluate the efficacy of ticagrelor when compared with clopidogrel in STEMI patients treated with fibrinolytic therapy.MethodsThis international, multicenter, randomized, open-label with blinded endpoint adjudication trial 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.ResultsThe 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: 0.93; 95% confidence interval: 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: 0.88; 95% confidence interval: 0.71 to 1.09; p = 0.25). The rates of major, fatal, and intracranial bleeding were similar between the ticagrelor and clopidogrel groups.ConclusionAmong patients age <75 years with STEMI, administration of ticagrelor after fibrinolytic therapy did not significantly reduce the frequency of cardiovascular events when compared with clopidogrel. (Ticagrelor in Patients With ST Elevation Myocardial Infarction Treated With Pharmacological Thrombolysis [TREAT]; NCT02298088) |
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| Keywords: | blinded adjudication dual antiplatelet therapy fibrinolysis myocardial infarction STEMI ticagrelor PCI percutaneous coronary intervention STEMI ST-segment elevation myocardial infarction TIMI Thrombolysis In Myocardial Infarction |
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