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

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Publication date: Available online 18 March 2019

Source: Journal of the American College of Cardiology

Author(s): 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, Nanci Valeis, Leopoldo S. Piegas

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.