title: What is the optimal duration of triple anti-platelet therapy in patients with acute myocardial infarction undergoing drug-eluting stent implantation?
abstract: BACKGROUND
  The optimal duration of triple anti-platelet therapy (DTAP) remains unclear in patients with acute myocardial infarction (AMI).
  
  
  METHODS
  We retrospectively analyzed 716 AMI patients who received TAP (aspirin, clopidogrel, and cilostazol) after drug-eluting stent (DES) implantation from November 2005 to May 2008. Mean age was 61.9 ± 11.70 years (male gender 74.1%) and mean duration of TAP was 98.1 ± 115.34 days. We compared the major adverse cardiovascular events [MACE, defined as the composite of cardiac death, non-fatal AMI, stent thrombosis, and target vessel revascularization (TVR)] between the group of DTAP ≥ 3 months (n = 497) and those of < 3 months (n = 219).
  
  
  RESULTS
  There were no significant differences in the incidences of cardiac death, non-fatal AMI, stent thrombosis, and TVR at 1-year follow-up between the two groups. However, the group of DTAP ≥ 3 months had lower incidence of MACE than those < 3 months (5.9% vs. 10.7%, p = 0.044). The rate of bleeding complications was similar between the two groups. By Cox regression analysis with propensity score adjustment, Killip class IV and DTAP ≥ 3 months were independent predictors of 1-year MACE [hazard ratio (HR) = 10.417; 95% confidence interval (CI) = 1.587-68.377, p = 0.015 and HR = 0.508; 95% CI = 0.269-0.956, p = 0.036].
  
  
  CONCLUSIONS
  Our data show that the DTAP ≥ 3 months is associated with better clinical outcomes compared with that of < 3 months in patients with AMI undergoing DES implantation without increasing bleeding complications.
authors.affiliation: Heart Center of Chonnam National University Hospital, Chonnam National University Research Institute of Medical Sciences, Gwangju, Republic of Korea.
authors.forename: Keun-Ho
authors.initials: KH
authors.lastname: Park
authors.forename: Myung Ho
authors.initials: MH
authors.lastname: Jeong
authors.forename: Min Goo
authors.initials: MG
authors.lastname: Lee
authors.forename: Jum Suk
authors.initials: JS
authors.lastname: Ko
authors.forename: Doo Sun
authors.initials: DS
authors.lastname: Sim
authors.forename: Nam Sik
authors.initials: NS
authors.lastname: Yoon
authors.forename: Hyun Ju
authors.initials: HJ
authors.lastname: Yoon
authors.forename: Young Joon
authors.initials: YJ
authors.lastname: Hong
authors.forename: Kye Hun
authors.initials: KH
authors.lastname: Kim
authors.forename: Hyung Wook
authors.initials: HW
authors.lastname: Park
authors.forename: Ju Han
authors.initials: JH
authors.lastname: Kim
authors.forename: Youngkeun
authors.initials: Y
authors.lastname: Ahn
authors.forename: Jeong Gwan
authors.initials: JG
authors.lastname: Cho
authors.forename: Jong Chun
authors.initials: JC
authors.lastname: Park
authors.forename: Jung Chaee
authors.initials: JC
authors.lastname: Kang
mesh_terms: D001241:Aspirin / Q000008:administration & dosage; D000077407:Cilostazol; D000077144:Clopidogrel; D003328:Coronary Thrombosis; D054855:Drug-Eluting Stents; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000628:therapy*; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage*; D012008:Recurrence; D012189:Retrospective Studies; D013777:Tetrazoles / Q000008:administration & dosage; D013988:Ticlopidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D013997:Time Factors
chemical_list: D010975:Platelet Aggregation Inhibitors; D013777:Tetrazoles; D000077144:Clopidogrel; D000077407:Cilostazol; D013988:Ticlopidine; D001241:Aspirin