The Official Journal of EuroPCR and the European Association of Percutaneous Coronary Interventions (EAPCI)

Ticagrelor versus Clopidogrel in patients with STEMI treated with thrombolysis: the MIRTOS trial

DOI: 10.4244/EIJ-D-20-00268

1. Cardiology Department, University Hospital of Heraklion, Greece, Greece
2. Clinical Therapeutics, Alexandra Hospital, University of Athens, Greece
3. 1st Cardiology Department, AHEPA University Hospital, Greece
4. 3rd Cardiology Department, Hippokration Hospital, Thessaloniki, Greece
5. 1st Cardiology Department, Ioannina University Hospital, Greece
6. 2nd Cardiology Department, Ioannina University Hospital, Greece
7. 1st Cardiology Department, Red Cross General Hospital, Athens, Greece
8. 2nd Cardiology Department, Red Cross General Hospital, Athens, Greece
9. Cardiology Department, Gennimatas General Hospital, Athens, Greece
10. Cardiology Department, Democritus University of Thrace, Alexandroupolis, Greece
11. Cardiology Department, Patras University Hospital, Greece
12. Hellenic Cardiovascular Research Society (HCRS), Greece
13. Cardiology Department, Halkida General Hospital, Greece
14. Cardiology Department, Venizeleio General Hospital, Heraklion, Greece
15. 2nd Cardiology Department, Hippokration Hospital, Thessaloniki, Greece
16. 1st Cardiology Department, AHEPA University Hospital, Thessaloniki, Greece
17. Cardiology Department, Livadia Hospital, Greece
18. Cardiology Department, Corfu Hospital, Greece
19. Cardiology Department, Preveza Hospital, Greece
20. Cardiology Department, Korinthos Hospital, Greece
21. Cardiology Department, Rethymnon Hospital, Greece
22. Cardiology Department, Kavala Hospital, Greece
23. Cardiology Department, Agios Pavlos Hospital, Thessaloniki, Greece
24. Department of Biostatistics, Medical School, University of Crete, Greece
Disclaimer:

As a public service to our readership, this article - peer reviewed by the Editors of EuroIntervention and external reviewers - has been published immediately upon acceptance as it was received in the last round of revision. The content of this article is the responsibility of the authors.

Please note that supplementary movies are not available online at this stage. Once a paper is published in its edited and formatted form, it will be accompanied online by any supplementary movies.

To read the full content of this article, please log in to download the PDF.

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 multicenter study of ticagrelor versus clopidogrel in STEMI subjects treated with fibrinolysis. We enrolled 335 patients <75 years old with STEMI eligible for thrombolysis, of which 167 were randomized 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 3-month follow-up period. From the 335 patients that were randomized, 259 underwent PCI (129 clopidogrel and 130 ticagrelor) and 154 angiographies were analyzable for 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 randomization 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 2 groups in MACE and major bleeding events.

Sign in to read and download the full article

Forgot your password?
No account yet? Sign up for free!
Create my pcr account

Join us for free and access thousands of articles from EuroIntervention, as well as presentations, videos, cases from PCRonline.com

Read next article
Rotational and orbital atherectomy, in-stent restenosis, clinical outcomes of stent thrombosis, coronary physiology in TAVI patients, invasive strategies for advanced heart failure, and more