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

Abstract Background The efficacy of ticagrelorin the long-term post ST-elevationmyocardial infarction (STEMI) treated with fibrinolytic therapyremains uncertain. Objectives To evaluate the efficacy of ticagrelorwhen compared with clopidogrelin 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 Results The combined outcome of cardiovascular mortality, myocardial infarction or stroke occurred in 129 of 1,913 patients (6.7%) receiving ticagrelorand in 137 of 1,886 patients (7.3%) receiving clopidogrel( hazard ratioof 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 ticagrelorand in 171 of 1,886 patients (9.1%) receiving clopidogrel( hazard ratioof 0.88; 95% CI, 0.71 to 1.09; P=0.25). The rates of major, fatal, and intracranial bleedingwere similar between the ticagrelorand clopidogrelgroups. Conclusions Among patients aged under 75 years with STEMI, administration of ticagrelorafter fibrinolytic therapydid not significantly reduce the frequency of cardiovascular events when compared with clopidogrel.