Background: ST-segment elevation myocardial infarction (STEMI) is a critical component of
acute coronary syndrome and is often managed with a pharmaco-invasive strategy when
primary percutaneous coronary intervention (pPCI) is not immediately available.
Although ticagrelor has demonstrated superior outcomes in pPCI settings, its efficacy and
safety compared with clopidogrel in a pharmaco-invasive approach remain less studied.
This study aimed to evaluate the safety and efficacy of ticagrelor compared with
clopidogrel in STEMI patients undergoing reperfusion with a pharmaco-invasive strategy.
Methods: This randomized controlled trial was conducted among 170 STEMI patients treated
with fibrinolytic therapy and scheduled for a pharmaco-invasive strategy. Patients were
randomized to receive either ticagrelor (the switch group) or clopidogrel (the no-switch
group) in addition to standard therapy. The primary outcomes were major bleeding
(safety) and a composite of death, reinfarction, or stroke (efficacy) within 6 months.
Results: The study found no significant differences in in-hospital outcomes, including
resuscitated cardiac arrest, shock, and major bleeding between the groups. At 6 months,
the composite efficacy endpoint occurred in 1.2% of the ticagrelor group compared with
4.7% in the clopidogrel group (P = 0.368). Kaplan-Meier analysis revealed a divergence
in event rates beginning in the fifth month, with the ticagrelor group exhibiting a slightly
higher event rate by the sixth month (10% vs 9.8%).
Conclusions: In STEMI patients treated with a pharmaco-invasive strategy, ticagrelor and
clopidogrel demonstrated similar safety profiles. Although the ticagrelor group exhibited
a lower incidence of the composite efficacy endpoint, this difference was not statistically
significant |
