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
Main Authors: Michalis Hamilos1; John Kanakakis2; Ioannis Anastasiou1; Charalambos Karvounis3; Vasilios Vasilikos4; John Goudevenos5; Lampros Michalis6; Michael Koutouzis7; Ioannis Tsiafoutis8; Konstantinos Raisakis9; Dimitrios Stakos10; George Hahalis11; Panos Vardas12;
Collaborators: Ioannis Mantas13; Emmanouil Foukarakis14; Ioannis Kanonidis15; Antonios Ziakas4; Stergios Tzikas16; Georgios Papaioannou17; Antonios Draganigos18; Grigorios Ikonomou19; Anastasia Damelou20; Ilias Samiotis21; Nikolaos Kampouridis22; Ioannis Tsounos23; Gregory Chlouverakis24; George Kochiadakis1; Stylianos Petousis1; Emmanouil Skalidis1; Evangelos Zacharis1; Fragkiskos Parthenakis1; Anastasia Nikolaou12;
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
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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.