Key result
Triple therapy with cilostazol linked to ~21% lower 1-month NACE post-AMI versus standard DAPT.
Why the study?
Potent P2Y12 inhibitors reduce ischemic events after AMI compared to clopidogrel, but their benefits are offset by increased major bleeding risk.
Does triple antiplatelet therapy with cilostazol improve net adverse clinical events in the first month after AMI in patients undergoing PCI with DES compared to standard or potent dual antiplatelet therapy?
Observational (n=16,643)
Yes
Does triple antiplatelet therapy with cilostazol improve net adverse clinical events in the first month after AMI in patients undergoing PCI with DES compared to standard or potent dual antiplatelet therapy?
Triple antiplatelet therapy with cilostazol improves early net clinical outcomes at one month post-AMI compared to standard or potent DAPT, primarily by avoiding the increased bleeding risk associated with potent P2Y12 inhibitors.
Answers are grounded in this paper and cite their sources.
May support cilostazol addition post-AMI; leaves open need for RCTs before practice change.
Current guidelines for the management of acute myocardial infarction (AMI) recommend potent P2Y12 inhibitors rather than clopidogrel to prevent ischemic events. However, their ischemic benefits are offset by an increased major bleeding risk. We compared the efficacy and safety of triple antiplatelet therapy with cilostazol in the first month after AMI. This study investigated 16,643 AMI patients who received percutaneous coronary intervention (PCI) with drug-eluting stents (DES) in nationwide, real-world, multicenter registries in Korea. Patients were divided into DAPT (aspirin and clopidogrel, n = 11,285), Triple (aspirin, clopidogrel and cilostazol, n = 2547), and Potent (aspirin and ticagrelor/prasugrel, n = 2811) groups. The primary outcomes were net adverse clinical events (NACE), a composite of death from any cause, myocardial infarction (MI), stroke, and TIMI major bleeding one month after AMI. After adjusting for covariates, there were no statistically significant differences in the risk of death from any cause, MI, or stroke between the three groups. However, the risk of TIMI major bleeding was significantly greater in the Potent group than in the DAPT and Triple groups (p < 0.001). Accordingly, NACE was significantly higher in the DAPT (HR 1.265; 95% CI 1.006−1.591, p = 0.044) and Potent groups (HR 1.515; 95% CI 1.142−2.011, p = 0.004) than in the Triple group. Triple antiplatelet therapy with cilostazol was associated with an improved net clinical outcome in the first month after AMI without increasing the risk of bleeding compared to potent or standard P2Y12 inhibitor-based DAPT.
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Byun et al. (2022) conducted an observational in Acute myocardial infarction (AMI) (n=16,643). Triple antiplatelet therapy (aspirin, clopidogrel, and cilostazol) vs. DAPT (aspirin and clopidogrel) or Potent DAPT (aspirin and ticagrelor/prasugrel) was evaluated on Net adverse clinical events (NACE), a composite of death from any cause, myocardial infarction (MI), stroke, and TIMI major bleeding at 1 month (HR 1.265 (DAPT vs Triple); HR 1.515 (Potent vs Triple), 95% CI 1.006-1.591; 1.142-2.011, p=0.044; 0.004). Triple antiplatelet therapy with cilostazol improved 1-month net clinical outcomes post-AMI compared to standard DAPT and potent P2Y12 inhibitor DAPT.
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