Iranian Heart Journal

Iranian Heart Journal

The Efficacy and Safety of Ticagrelor Compared With Clopidogrel in Patients With ST-Segment Elevation Myocardial Infarction Scheduled for a Pharmaco-Invasive Reperfusion Strategy

Document Type : Original Article

Authors
Ahmed Mahmoud Bendary 1
Osama Sanad Arafa 1
Zainab Gomaa Gamal Awad 2
Yasser Hosny Abd El Rahman 1
1 Cardiovascular Medicine Department, Faculty of Medicine, Benha University, Benha, Egypt.
2 New Cairo Specialized Hospital, Cairo, Egypt.
Abstract
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. (Iranian Heart Journal 2025; 26(2): 39-48)
Keywords
STEMI
Pharmaco-invasive strategy
Ticagrelor
Clopidogrel
Randomized controlled trial
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Iranian Heart Journal
Volume 26, Issue 2
Spring 2025
Pages 39-48