Triple versus dual antiplatelet therapy in patients with acute ST-segment elevation myocardial infarction undergoing
Kang-Yin Chen1, Seung-Woon Rha, Yong-Jian Li
1Korea University Guro Hospital, Seoul, Korea.
Insights
Triple antiplatelet therapy, including aspirin, clopidogrel, and cilostazol, showed better outcomes than dual therapy in ST-segment elevation myocardial infarction patients undergoing stenting. This approach reduced cardiac and total deaths, with benefits seen in older, female, and diabetic patients.
Area of Science:
- Cardiology
- Interventional Cardiology
- Pharmacology
Background:
- The optimal antiplatelet strategy post-primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) using drug-eluting stents (DES) is debated.
- Dual antiplatelet therapy (DAPT) versus triple antiplatelet therapy (TAPT) efficacy remains unclear in the current DES era.
Purpose of the Study:
- To compare the clinical outcomes of TAPT versus DAPT in STEMI patients undergoing primary PCI with DES.
- To identify patient subgroups that may benefit more from TAPT.
Main Methods:
- Retrospective analysis of 4203 STEMI patients from the Korean Acute Myocardial Infarction Registry (KAMIR).
- Patients received either DAPT (aspirin + clopidogrel) or TAPT (aspirin + clopidogrel + cilostazol for ≥1 month).
- Comparison of major adverse cardiac events (MACE) and bleeding events at 8 months between the two groups.
Main Results:
- TAPT group showed similar major bleeding events but significantly lower in-hospital mortality compared to the DAPT group.
- At 8 months, TAPT was associated with significantly lower cardiac death (aOR 0.52), total death (aOR 0.60), and total MACE (aOR 0.74).
- Subgroup analyses indicated greater benefits from TAPT in older (>65 years), female, and diabetic patients.
Conclusions:
- Triple antiplatelet therapy (aspirin, clopidogrel, and cilostazol) appears superior to dual antiplatelet therapy in STEMI patients undergoing primary PCI with DES.
- These findings support the consideration of TAPT for selected STEMI patients to improve clinical outcomes and reduce mortality.
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.
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