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

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 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.