Key result
Triple antiplatelet treatment significantly reduced the risk of MACE after stent implantation in patients with ACS compared to dual therapy (OR 0.72; 95% CI 0.61-0.85; P<0.001).
Why the study?
Does triple antiplatelet treatment (cilostazol added to aspirin and clopidogrel) reduce major adverse cardiac events in high-risk patients after coronary stent implantation compared to dual antiplatelet therapy?
Meta-Analysis (n=9,553)
Does triple antiplatelet treatment (cilostazol added to aspirin and clopidogrel) reduce major adverse cardiac events in high-risk patients after coronary stent implantation compared to dual antiplatelet therapy?
Odds Ratio: 0.72 (95% CI 0.61–0.85)
p-value: p=<0.001
Triple antiplatelet therapy with cilostazol added to aspirin and clopidogrel significantly reduces MACE, particularly all-cause mortality, in ACS patients after stent implantation without increasing bleeding risk.
TAPT may lower MACE and mortality in ACS post-stenting without excess bleeding; leaves overall and complex-lesion benefit open.
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. Conclusion: 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.
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Fan et al. (2016) conducted a meta-analysis in Complex coronary artery lesions or acute coronary syndrome (ACS) after coronary stent implantation (n=9,553). Triple antiplatelet treatment (cilostazol added to aspirin plus clopidogrel) vs. Dual antiplatelet therapy was evaluated on Major adverse cardiac events (MACE), including all-cause mortality, myocardial infarction, and target vessel revascularization (OR 0.72, 95% CI 0.61-0.85, p=<0.001). Triple antiplatelet treatment significantly reduced the risk of MACE after stent implantation in patients with ACS compared to dual therapy (OR 0.72; 95% CI 0.61-0.85; P<0.001).
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