Triple antiplatelet therapy was associated with a lower incidence of total major adverse cardiac events at 8 months compared to dual therapy (adjusted OR 0.74; 95% CI 0.58-0.95; P=0.019).
Cohort (n=4,203)
Yes
Odds Ratio: 0.74 (95% CI 0.58–0.95)
p-value: p=0.019
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. METHODS AND 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.
Chen et al. (Tue,) conducted a cohort in Acute ST-segment elevation myocardial infarction (n=4,203). Triple antiplatelet therapy (aspirin plus clopidogrel plus cilostazol) vs. Dual antiplatelet therapy (aspirin plus clopidogrel) was evaluated on Total major adverse cardiac events (OR 0.74, 95% CI 0.58-0.95, p=0.019). Triple antiplatelet therapy was associated with a lower incidence of total major adverse cardiac events at 8 months compared to dual therapy (adjusted OR 0.74; 95% CI 0.58-0.95; P=0.019).
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