title: The clinical outcomes of triple antiplatelet therapy versus dual antiplatelet therapy for high-risk patients after coronary stent implantation: a meta-analysis of 11 clinical trials and 9,553 patients.
abstract: BACKGROUND
  The optimal antiplatelet regimen after in-coronary intervention among patients presenting with complex coronary artery lesions or acute coronary syndrome (ACS) has remained unclear. This study sought to evaluate the clinical outcomes of triple antiplatelet treatment (TAPT) (cilostazol added to aspirin plus clopidogrel) in these patients.
  
  
  METHODS
  The PubMed, EMBASE, MEDLINE, and other Internet sources were searched for relevant articles. The primary end point was major adverse cardiac events (MACE), including all-cause mortality, myocardial infarction, and target vessel revascularization. The incidence of definite/probable stent thrombosis and bleeding were analyzed as the safety end points.
  
  
  RESULTS
  Eleven clinical trials involving 9,553 patients were analyzed. The risk of MACE was significantly decreased following TAPT after stent implantation in the ACS subgroup (odds ratio [OR]: 0.72; 95% confidence interval [CI]: 0.61-0.85;P<0.001), which might mainly result from the lower risk of all-cause mortality in this subset (OR: 0.62; 95% CI: 0.48-0.80;P<0.001). The risk of bleeding was not increased with respect to TAPT.
  
  
  CONCLUSIONS
  TAPT after stent implantation was associated with feasible benefits on reducing the risk of MACE, especially on reducing the incidence of all-cause mortality among patients suffering from ACS, without higher incidence of bleeding. Larger and more powerful randomized trials are still warranted to prove the superiority of TAPT for such patients.
authors: Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing.
authors: Zhong-Guo
authors: ZG
authors: Fan
authors: Department of Cardiology, Taixing People's Hospital, Yangzhou University, Taizhou.
authors: Guo-Bin
authors: GB
authors: Ding
authors: Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing; Department of Cardiology, Nanjing Heart Center, Nanjing, People's Republic of China.
authors: Xiao-Bo
authors: XB
authors: Li
authors: Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing; Department of Cardiology, Nanjing Heart Center, Nanjing, People's Republic of China.
authors: Xiao-Fei
authors: XF
authors: Gao
authors: Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing.
authors: Ya-Li
authors: YL
authors: Gao
authors: Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing; Department of Cardiology, Nanjing Heart Center, Nanjing, People's Republic of China.
authors: Nai-Liang
authors: NL
authors: Tian
mesh_terms: D002986:Clinical Trials as Topic; D003324:Coronary Artery Disease / Q000188:drug therapy* / Q000601:surgery; D006801:Humans; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D012307:Risk Factors; D015607:Stents / Q000009:adverse effects*; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors
keywords: acute coronary syndrome; complex lesions; dual antiplatelet treatment; stent implantation; triple antiplatelet treatment