title: Triple versus dual antiplatelet therapy in patients with acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention.
abstract: 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.
authors.affiliation: Korea University Guro Hospital, Seoul, Korea.
authors.forename: Kang-Yin
authors.initials: KY
authors.lastname: Chen
authors.forename: Seung-Woon
authors.initials: SW
authors.lastname: Rha
authors.forename: Yong-Jian
authors.initials: YJ
authors.lastname: Li
authors.forename: Kanhaiya L
authors.initials: KL
authors.lastname: Poddar
authors.forename: Zhe
authors.initials: Z
authors.lastname: Jin
authors.forename: Yoshiyasu
authors.initials: Y
authors.lastname: Minami
authors.forename: Lin
authors.initials: L
authors.lastname: Wang
authors.forename: Eung Ju
authors.initials: EJ
authors.lastname: Kim
authors.forename: Chang Gyu
authors.initials: CG
authors.lastname: Park
authors.forename: Hong Seog
authors.initials: HS
authors.lastname: Seo
authors.forename: Dong Joo
authors.initials: DJ
authors.lastname: Oh
authors.forename: Myung Ho
authors.initials: MH
authors.lastname: Jeong
authors.forename: Young Keun
authors.initials: YK
authors.lastname: Ahn
authors.forename: Taek Jong
authors.initials: TJ
authors.lastname: Hong
authors.forename: Young Jo
authors.initials: YJ
authors.lastname: Kim
authors.forename: Seung Ho
authors.initials: SH
authors.lastname: Hur
authors.forename: In Whan
authors.initials: IW
authors.lastname: Seong
authors.forename: Jei Keon
authors.initials: JK
authors.lastname: Chae
authors.forename: Myeong Chan
authors.initials: MC
authors.lastname: Cho
authors.forename: Jang Ho
authors.initials: JH
authors.lastname: Bae
authors.forename: Dong Hoon
authors.initials: DH
authors.lastname: Choi
authors.forename: Yang Soo
authors.initials: YS
authors.lastname: Jang
authors.forename: In Ho
authors.initials: IH
authors.lastname: Chae
authors.forename: Chong Jin
authors.initials: CJ
authors.lastname: Kim
authors.forename: Jung Han
authors.initials: JH
authors.lastname: Yoon
authors.forename: Wook Sung
authors.initials: WS
authors.lastname: Chung
authors.forename: Ki Bae
authors.initials: KB
authors.lastname: Seung
authors.forename: Seung Jung
authors.initials: SJ
authors.lastname: Park
mesh_terms: 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
chemical_list: D010975:Platelet Aggregation Inhibitors; D013777:Tetrazoles; D000077144:Clopidogrel; D000077407:Cilostazol; D013988:Ticlopidine; D001241:Aspirin