Key result
In patients with acute myocardial infarction and renal dysfunction, triple antiplatelet therapy did not significantly reduce the 1-year risk of major adverse cardiac events compared to dual therapy (adjusted OR 0.65).
Why the study?
Does triple antiplatelet therapy reduce MACE in AMI patients with renal dysfunction undergoing PCI compared to dual antiplatelet therapy?
Cohort (n=2,288)
Yes
Does triple antiplatelet therapy reduce MACE in AMI patients with renal dysfunction undergoing PCI compared to dual antiplatelet therapy?
In AMI patients with renal dysfunction undergoing PCI, adding cilostazol to aspirin and clopidogrel improves 1-month MACE and in-hospital mortality but does not provide a 1-year MACE benefit.
Answers are grounded in this paper and cite their sources.
No 1-year MACE reduction with triple therapy; hypothesis-generating for short-term gains, needs RCT confirmation.
BACKGROUND: The question as to whether triple antiplatelet therapy is superior to dual antiplatelet therapy for patients with acute myocardial infarction (AMI) and renal dysfunction, who undergo percutaneous coronary intervention (PCI), is unresolved. METHODS AND RESULTS: As part of the Korea Acute Myocardial Infarction Registry (KAMIR), 2,288 AMI patients with renal dysfunction (glomerular filtration rate <60ml/min·1.73m(2)) received either dual (aspirin plus clopidogrel; n=1,587) or triple (aspirin plus clopidogrel and cilostazol; n=701) antiplatelet therapy. Major adverse cardiac events (MACE) at 1 month and 1 year were compared between these 2 groups. On comparison with the dual therapy group, the triple therapy group had a similar incidence of major bleeding events but a significantly lower incidence of in-hospital mortality. The MACE rate at 1 month was significantly higher for the dual therapy group than for the triple therapy group (16.3% vs. 11.1%, P<0.05), and this difference was mainly attributed to death rather than repeat PCI (12.9% vs. 9.1%, P<0.05). The MACE rate at 1 year and the MACE-free survival time, however, did not differ between the groups. CONCLUSIONS: In AMI patients with renal dysfunction, triple antiplatelet therapy has a favorable in-hospital and short-term MACE impact, but it does not have an impact on the 1-year MACE-free survival.
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Choi et al. (2012) conducted a cohort in Acute myocardial infarction with renal dysfunction (n=2,288). Triple antiplatelet therapy (aspirin, clopidogrel, cilostazol) vs. Dual antiplatelet therapy (aspirin, clopidogrel) was evaluated on 1-year major adverse cardiac events (MACE) (Adjusted OR 0.65, 95% CI 0.27-1.61, p=0.353). In patients with acute myocardial infarction and renal dysfunction, triple antiplatelet therapy did not significantly reduce the 1-year risk of major adverse cardiac events compared to dual therapy (adjusted OR 0.65).
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