title: Long-term effectiveness and safety of triple versus dual antiplatelet therapy after percutaneous coronary intervention for unprotected left main coronary artery disease.
abstract: OBJECTIVE
  We sought to compare the long-term effectiveness and safety of triple antiplatelet therapy (TAPT) versus dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) for unprotected left main coronary artery disease (uLMCAD).
  
  
  BACKGROUND
  An additional strategy to reduce recurrent ischemia after PCI for uLMCAD is needed to improve the long-term clinical outcomes and match the efficacy of bypass surgery.
  
  
  METHODS
  We evaluated 245 patients who underwent PCI with drug-eluting stents for uLMCA stenosis of at least 50% from the Sejong General Institute PCI database between April 2003 and December 2010. TAPT was defined as the addition of cilostazol for at least 3 months to conventional DAPT after PCI.
  
  
  RESULTS
  A total of 124 patients received TAPT and 121 patients received DAPT. The TAPT group had a higher number of male patients, need for the two-stent technique, and Synergy between percutaneous coronary intervention with Taxus and Cardiac Surgery (SYNTAX) scores and longer stent length compared with the DAPT group. During a median 30.6 months, major adverse cardiac and cerebrovascular events (MACCE) occurred in 43 patients (17.6%): 23 (18.5%) in the TAPT group and 20 (16.5%) in the DAPT group (P=0.68). In the multivariate analysis, TAPT was not associated with a lower incidence of MACCE (hazard ratio: 0.69, 95% confidence interval: 0.34-1.43). Thrombolysis in myocardial infarction (TIMI) major and minor bleeding occurred at similar rates (5.6 vs. 3.3%, P=0.565, for TIMI major bleeding; and 14.5 vs. 14.9%, P=0.718, for TIMI minor bleeding).
  
  
  CONCLUSIONS
  TAPT after drug-eluting stent implantation in patients with uLMCAD did not improve the long-term clinical outcome when compared with conventional DAPT, although it was a safe strategy.
authors.affiliation: aDepartment of Internal Medicine, Division of Cardiology, Sejong General Hospital, Bucheon bDepartment of Internal Medicine, Konkuk University School of Medicine, Division of Cardiology, Konkuk University Hospital, Seoul, Republic of Korea.
authors.forename: Hyun Jong
authors.initials: HJ
authors.lastname: Lee
authors.forename: Cheol Woong
authors.initials: CW
authors.lastname: Yu
authors.forename: Heung Kon
authors.initials: HK
authors.lastname: Hwang
authors.forename: Rak Kyeong
authors.initials: RK
authors.lastname: Choi
authors.forename: Jin Sik
authors.initials: JS
authors.lastname: Park
authors.forename: Hu
authors.initials: H
authors.lastname: Li
authors.forename: Young Moo
authors.initials: YM
authors.lastname: Ro
mesh_terms: D000368:Aged; D002561:Cerebrovascular Disorders / Q000401:mortality / Q000517:prevention & control; D000077407:Cilostazol; D023903:Coronary Restenosis / Q000401:mortality / Q000517:prevention & control; D023921:Coronary Stenosis / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D003328:Coronary Thrombosis / Q000401:mortality / Q000517:prevention & control; D004359:Drug Therapy, Combination; D054855:Drug-Eluting Stents; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000401:mortality / Q000517:prevention & control; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D016016:Proportional Hazards Models; D012042:Registries; D056910:Republic of Korea; D012189:Retrospective Studies; D012307:Risk Factors; D013777:Tetrazoles / Q000627:therapeutic use; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors; D013777:Tetrazoles; D000077407:Cilostazol