Triple versus dual antiplatelet therapy in patients with acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention.
BACKGROUND
Whether triple antiplatelet therapy is superior or similar to dual antiplatelet therapy in patients with acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention in the era of drug-eluting stents remains unclear.


RESULTS
A total of 4203 ST-segment elevation myocardial infarction patients who underwent primary percutaneous coronary intervention with drug-eluting stents were analyzed retrospectively in the Korean Acute Myocardial Infarction Registry (KAMIR). They received either dual (aspirin plus clopidogrel; dual group; n=2569) or triple (aspirin plus clopidogrel plus cilostazol; triple group; n=1634) antiplatelet therapy. The triple group received additional cilostazol at least for 1 month. Various major adverse cardiac events at 8 months were compared between these 2 groups. Compared with the dual group, the triple group had a similar incidence of major bleeding events but a significantly lower incidence of in-hospital mortality. Clinical outcomes at 8 months showed that the triple group had significantly lower incidences of cardiac death (adjusted odds ratio, 0.52; 95% confidence interval, 0.32 to 0.84; P=0.007), total death (adjusted odds ratio, 0.60; 95% confidence interval, 0.41 to 0.89; P=0.010), and total major adverse cardiac events (adjusted odds ratio, 0.74; 95% confidence interval, 0.58 to 0.95; P=0.019) than the dual group. Subgroup analysis showed that older (>65 years old), female, and diabetic patients got more benefits from triple antiplatelet therapy than their counterparts who received dual antiplatelet therapy.


CONCLUSIONS
Triple antiplatelet therapy seems to be superior to dual antiplatelet therapy in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention with drug-eluting stents. These results may provide the rationale for the use of triple antiplatelet therapy in these patients.
Chen
Kang-Yin
KY
Korea University Guro Hospital, Seoul, Korea.
Rha
Seung-Woon
SW
Li
Yong-Jian
YJ
Poddar
Kanhaiya L
KL
Jin
Zhe
Z
Minami
Yoshiyasu
Y
Wang
Lin
L
Kim
Eung Ju
EJ
Park
Chang Gyu
CG
Seo
Hong Seog
HS
Oh
Dong Joo
DJ
Jeong
Myung Ho
MH
Ahn
Young Keun
YK
Hong
Taek Jong
TJ
Kim
Young Jo
YJ
Hur
Seung Ho
SH
Seong
In Whan
IW
Chae
Jei Keon
JK
Cho
Myeong Chan
MC
Bae
Jang Ho
JH
Choi
Dong Hoon
DH
Jang
Yang Soo
YS
Chae
In Ho
IH
Kim
Chong Jin
CJ
Yoon
Jung Han
JH
Chung
Wook Sung
WS
Seung
Ki Bae
KB
Park
Seung Jung
SJ
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D001241:Aspirin / Q000627:therapeutic use; D000077407:Cilostazol; D000077144:Clopidogrel; D003131:Combined Modality Therapy; D003328:Coronary Thrombosis / Q000517:prevention & control*; D004359:Drug Therapy, Combination; D054855:Drug-Eluting Stents; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D016016:Proportional Hazards Models; D012042:Registries; D012189:Retrospective Studies; D013777:Tetrazoles / Q000627:therapeutic use; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000627:therapeutic use
D010975:Platelet Aggregation Inhibitors; D013777:Tetrazoles; D000077144:Clopidogrel; D000077407:Cilostazol; D013988:Ticlopidine; D001241:Aspirin