Ticagrelor Versus Clopidogrel in Patients With STEMI Treated With Fibrinolysis TREAT Trial

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY

卷:73

Article

Berwanger, Otavio¹  Lopes, Renato D.^2,3  Moia, Diogo D. F.¹  Fonseca, Francisco A.³  Jiang, Lixin⁴  Goodman, Shaun G.^5,6  Nicholls, Stephen J.⁷  Parkhomenko, Alexander⁸  Averkov, Oleg⁹  Tajer, Carlos¹⁰  Malaga, German¹¹  Saraiva, Jose F. K.¹²  Guimaraes, Helio P.¹  de Barros e Silva, Pedro G. M.¹  Damiani, Lucas P.¹  Santos, Renato H. N.¹  Paisani, Denise M.¹  Miranda, Tamiris A.¹  Valeis, Nanci¹  Piegas, Leopoldo S.¹³  Granger, Christopher B.²  White, Harvey D.¹⁴  Nicolau, Jose C.¹⁵ 

[1] Heart Hosp HCor, Res Inst, Abilio Soares St 250,12th Floor, BR-04005000 Sao Paulo, SP, Brazil

[2] Duke Clin Res Inst, Durham, NC USA

[3] Univ Fed Sao Paulo, Sao Paulo, Brazil

[4] Fuwai Hosp, Beijing, Peoples R China

[5] Univ Toronto, St Michaels Hosp, CHRC, Toronto, ON, Canada

[6] Univ Toronto, St Michaels Hosp, Div Cardiol, Toronto, ON, Canada

[7] Monash Univ, Monash Cardiovasc Res Ctr, Melbourne, Vic, Australia

[8] Inst Cardiol, Emergency Cardiol Dept, Kiev, Ukraine

[9] Pirogov Russian Natl Res Med Univ, Moscow, Russia

[10] Hosp Alta Complejidad El Cruce, Buenos Aires, DF, Argentina

[11] Univ Peruana Cayetano Heredia, Sch Med, Lima, Peru

[12] Hosp & Maternidade Celso Pierro, Campinas, SP, Brazil

[13] Heart Hosp HCor, Sao Paulo, Brazil

[14] Auckland City Hosp, Auckland Dist Hlth Board, Auckland, New Zealand

[15] Univ Sao Paulo, Fac Med, Hosp Clin HCFMUSP, Inst Coracao InCor, Sao Paulo, Brazil

关键词: blinded adjudication;    dual antiplatelet therapy;    fibrinolysis;    myocardial infarction;    STEMI;    ticagrelor;   

DOI  :  10.1016/j.jacc.2019.03.011

来源: Elsevier

【 摘 要 】

BACKGROUND The efficacy of ticagrelor in the long-term post-ST-segment elevation myocardial infarction (STEMI) treated with fibrinolytic therapy remains uncertain. OBJECTIVES The purpose of this study was to evaluate the efficacy of ticagrelor when compared with clopidogrel in STEMI patients treated with fibrinolytic therapy. METHODS This 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. 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: 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. CONCLUSION Among 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. (C) 2019 by the American College of Cardiology Foundation.

【 授权许可】

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