Triple Versus Dual Antiplatelet Therapy in Patients With Acute ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

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. A total of 4203 ST-segment elevation myoc...

Full description

Saved in:
Bibliographic Details
Published in:Circulation (New York, N.Y.) N.Y.), 2009-06, Vol.119 (25), p.3207-3214
Main Authors: CHEN, Kang-Yin, RHA, Seung-Woon, DONG JOO OH, MYUNG HO JEONG, YOUNG KEUN AHN, TAEK JONG HONG, YOUNG JO KIM, SEUNG HO HUR, IN WHAN SEONG, JEI KEON CHAE, MYEONG CHAN CHO, JANG HO BAE, LI, Yong-Jian, DONG HOON CHOI, YANG SOO JANG, IN HO CHAE, CHONG JIN KIM, JUNG HAN YOON, WOOK SUNG CHUNG, KI BAE SEUNG, SEUNG JUNG PARK, PODDAR, Kanhaiya L, ZHE JIN, MINAMI, Yoshiyasu, LIN WANG, EUNG JU KIM, CHANG GYU PARK, HONG SEOG SEO
Format: Article
Language:English
Subjects:
Aged
Angioplasty, Balloon, Coronary
Aspirin - therapeutic use
Biological and medical sciences
Blood and lymphatic vessels
Blood. Blood coagulation. Reticuloendothelial system
Cardiology. Vascular system
Combined Modality Therapy
Coronary Thrombosis - prevention & control
Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous
Drug Therapy, Combination
Drug-Eluting Stents
Electrocardiography
Female
Humans
Male
Medical sciences
Middle Aged
Myocardial Infarction - diagnosis
Myocardial Infarction - drug therapy
Myocardial Infarction - mortality
Pharmacology. Drug treatments
Platelet Aggregation Inhibitors - therapeutic use
Proportional Hazards Models
Registries
Retrospective Studies
Tetrazoles - therapeutic use
Ticlopidine - analogs & derivatives
Ticlopidine - therapeutic use
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary: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. 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. 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.
ISSN:0009-7322
1524-4539
DOI:10.1161/CIRCULATIONAHA.108.822791