Key result
Triple antiplatelet therapy shows no benefit over DAPT for MACCE after left main PCI.
Why the study?
An additional strategy to reduce recurrent ischemia after PCI for unprotected left main coronary artery disease is needed to improve long-term clinical outcomes and match bypass surgery efficacy.
Does triple antiplatelet therapy reduce major adverse cardiac and cerebrovascular events compared to dual antiplatelet therapy in patients undergoing PCI for unprotected left main coronary artery disease?
Cohort (n=245)
Does triple antiplatelet therapy reduce major adverse cardiac and cerebrovascular events compared to dual antiplatelet therapy in patients undergoing PCI for unprotected left main coronary artery disease?
Hazard Ratio: 0.69 (95% CI 0.34–1.43)
Absolute Event Rate: 18.5% vs 16.5%
p-value: p=0.68
The addition of cilostazol to conventional dual antiplatelet therapy after PCI for unprotected left main coronary artery disease did not improve long-term clinical outcomes, though it did not significantly increase bleeding risk.
TAPT was not associated with fewer MACCE after left main PCI; leaves open whether randomized trials would demonstrate benefit.
OBJECTIVES: We sought to compare the long-term effectiveness and safety of triple antiplatelet therapy (TAPT) versus dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) for unprotected left main coronary artery disease (uLMCAD). BACKGROUND: An additional strategy to reduce recurrent ischemia after PCI for uLMCAD is needed to improve the long-term clinical outcomes and match the efficacy of bypass surgery. METHODS: We evaluated 245 patients who underwent PCI with drug-eluting stents for uLMCA stenosis of at least 50% from the Sejong General Institute PCI database between April 2003 and December 2010. TAPT was defined as the addition of cilostazol for at least 3 months to conventional DAPT after PCI. RESULTS: A total of 124 patients received TAPT and 121 patients received DAPT. The TAPT group had a higher number of male patients, need for the two-stent technique, and Synergy between percutaneous coronary intervention with Taxus and Cardiac Surgery (SYNTAX) scores and longer stent length compared with the DAPT group. During a median 30.6 months, major adverse cardiac and cerebrovascular events (MACCE) occurred in 43 patients (17.6%): 23 (18.5%) in the TAPT group and 20 (16.5%) in the DAPT group (P=0.68). In the multivariate analysis, TAPT was not associated with a lower incidence of MACCE (hazard ratio: 0.69, 95% confidence interval: 0.34-1.43). Thrombolysis in myocardial infarction (TIMI) major and minor bleeding occurred at similar rates (5.6 vs. 3.3%, P=0.565, for TIMI major bleeding; and 14.5 vs. 14.9%, P=0.718, for TIMI minor bleeding). CONCLUSION: TAPT after drug-eluting stent implantation in patients with uLMCAD did not improve the long-term clinical outcome when compared with conventional DAPT, although it was a safe strategy.
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Lee et al. (2013) conducted a cohort in unprotected left main coronary artery disease (uLMCAD) (n=245). Triple antiplatelet therapy (TAPT) vs. Dual antiplatelet therapy (DAPT) was evaluated on major adverse cardiac and cerebrovascular events (MACCE) (HR 0.69, 95% CI 0.34-1.43, p=0.68). Triple antiplatelet therapy after PCI for unprotected left main coronary artery disease did not reduce MACCE compared with dual antiplatelet therapy (HR 0.69; 95% CI 0.34-1.43).
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