For STEMI, ticagrelor ties clopidogrel for 12-month safety, efficacy: TREAT

  • Berwanger O & al.
  • J Am Coll Cardiol
  • 12 Mar 2019

  • International Clinical Digest
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  • For patients with ST-elevation myocardial infarction (STEMI) treated with fibrinolytic therapy, ticagrelor (Brilinta, Amneal) showed similar safety and efficacy to clopidogrel (Plavix, Bristol-Myers Squibb) at 12 months. 
  • Result is exploratory.
  • Editorial performed meta-analysis of TREAT and PLATO, linking ticagrelor to 13% relative risk reduction of cardiovascular death, myocardial infarction, or stroke in patients with STEMI.

Why this matters

  • Dual antiplatelet therapy (DAPT) with aspirin and clopidogrel reduces major cardiovascular events in patients with STEMI.
  • Ticagrelor acts faster and offers better P2Y12 inhibition vs clopidogrel.
  • PLATO demonstrated lower rate of cardiovascular events with ticagrelor after primary percutaneous coronary intervention (PCI) in a STEMI population not treated with fibrinolytics.
  • TREAT has already reported acceptable 30-day safety results.

Key results

  • Ticagrelor vs clopidogrel:
    • Primary outcome: 6.7% (129/1913) vs 7.3% (137/1886); HR, 0.93 (95% CI, 0.73-1.18; P=.53).
    • Dyspnea: 23.9% vs 13.7%.
    • Similar between-group rate of major, fatal, and intracranial bleeding.
    • Minor bleeding more frequent with ticagrelor.

Study design

  • International, multicenter, randomized, open-label TREAT (n=3799).
  • Participants aged
  • They were randomly assigned to daily ticagrelor vs clopidogrel.
  • Outcome: 12-month composite of cardiovascular mortality, myocardial infarction, or stroke.
  • Funding: AstraZeneca.


  • Underpowered to assess 12-month efficacy.
  • Older patients excluded.
  • Open-label.

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