Ticagrelor versus clopidogrel in patients with STEMI treated with thrombolysis: the MIRTOS trial
Michalis Hamilos, John Kanakakis, Ioannis Anastasiou, Charalambos Karvounis, Vasilios Vasilikos, John Goudevenos, Lampros Michalis, Michalis Koutouzis, Ioannis Tsiafoutis, Konstantinos Raisakis, Dimitrios Stakos, George Hahalis, Panos Vardas, Collaborators, Ioannis Mantas, Emmanouil Foukarakis, Ioannis Kanonidis, Antonios Ziakas, Stergios Tzikas, Georgios Papaioannou, Antonios Draganigos, Grigorios Ikonomou, Anastasia Damelou, Ilias Samiotis, Nikolaos Kampouridis, Ioannis Tsounos, Gregory Chlouverakis, George Kochiadakis, Stylianos Petousis, Emmanouil Skalidis, Evangelos Zacharis, Fragkiskos Parthenakis, Anastasia Nikolaou, Michalis Hamilos, John Kanakakis, Ioannis Anastasiou, Charalambos Karvounis, Vasilios Vasilikos, John Goudevenos, Lampros Michalis, Michalis Koutouzis, Ioannis Tsiafoutis, Konstantinos Raisakis, Dimitrios Stakos, George Hahalis, Panos Vardas, Collaborators, Ioannis Mantas, Emmanouil Foukarakis, Ioannis Kanonidis, Antonios Ziakas, Stergios Tzikas, Georgios Papaioannou, Antonios Draganigos, Grigorios Ikonomou, Anastasia Damelou, Ilias Samiotis, Nikolaos Kampouridis, Ioannis Tsounos, Gregory Chlouverakis, George Kochiadakis, Stylianos Petousis, Emmanouil Skalidis, Evangelos Zacharis, Fragkiskos Parthenakis, Anastasia Nikolaou
Abstract
Aims: We aimed to demonstrate whether coronary microvascular function is improved after ticagrelor administration compared to clopidogrel administration in STEMI subjects undergoing thrombolysis.
Methods and results: MIRTOS is a multicentre study of ticagrelor versus clopidogrel in STEMI subjects treated with fibrinolysis. We enrolled 335 patients <75 years old with STEMI eligible for thrombolysis, of whom 167 were randomised to receive clopidogrel and 168 to receive ticagrelor together with thrombolysis. Primary outcome was the difference in post-PCI corrected TIMI frame count (CTFC). All clinical events were recorded in a three-month follow-up period. From the 335 patients who were randomised, 259 underwent PCI (129 clopidogrel and 130 ticagrelor) and 154 angiographies were analysable for the study primary endpoint. No significant difference was found between the clopidogrel (n=85) and ticagrelor (n=69) groups for CTFC (24.33±17.35 vs 28.33±17.59, p=0.10). No significant differences were observed in MACE and major bleeding events between randomisation groups (OR 2.0, 95% CI: 0.18-22.2, p=0.99).
Conclusions: Thrombolysis with ticagrelor in patients <75 years old was not able to demonstrate superiority compared to clopidogrel in terms of microvascular injury, while there was no difference between the two groups in MACE and major bleeding events.
Trial registration: ClinicalTrials.gov Identifier: NCT02429271. EudraCT Number 2014-004082-25.
Conflict of interest statement
M. Hamilos reports grants and personal fees from HCRS, and personal fees from AstraZeneca and Sanofi. J. Kanakakis reports grants from HCRS, and personal fees from AstraZeneca and Sanofi. I. Anastasiou reports non-financial support from HCRS. C. Karvounis reports non-financial support from HCRS, and personal fees from AstraZeneca. J. Goudevenos reports non-financial support from HCRS. L. Michalis reports personal fees from Sanofi, AstraZeneca, Elpen and Bayer Hellas. M. Koutouzis reports grants from HCRS. I. Tsiafoutis reports grants from HCRS and AstraZeneca. K. Raisakis reports grants from HCRS. D. Stakos reports grants from HCRS. P. Vardas reports personal fees from Menarini International, Dean Medicus, Servier, the European Society of Cardiology and Hygeia Hospitals Group. I. Mantas reports non-financial support from HCRS. E. Foukarakis reports grants from HCRS. G. Papaioannou reports non-financial support from HCRS. G. Ikonomou reports non-financial support from HCRS. A. Damelou reports grants from HCRS. I. Samiotis reports non-financial support from HCRS. N. Kampouridis reports non-financial support from HCRS. I. Tsounos reports non-financial support from HCRS. G. Chlouverakis reports grants from HCRS. G. Kochiadakis reports non-financial support from HCRS, personal fees from AstraZeneca and Sanofi, and grants from Innovis, Servier and Abbott. S. Petousis reports grants from HCRS. E. Skalidis reports grants from HCRS, and personal fees from AstraZeneca, Medtronic, Boehringer-Ingelheim and Pfizer. E. Zacharis reports non-financial support from HCRS, and personal fees from Sanofi and Amgen. F. Parthenakis reports grants from HCRS. The other authors have no conflicts of interest to declare.
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Source: PubMed