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Triple vs. dual antiplatelet therapy in patients with acute myocardial infarction and renal dysfunction
Young Hwan Choi1, Sang Heon Suh, Joon Seok Choi
1Department of Internal Medicine, Chonnam National University Medical School, Jaebongro 671, Dongku, Gwangju 501-757, Korea.
Insights
Triple antiplatelet therapy in acute myocardial infarction (AMI) patients with renal dysfunction shows improved short-term outcomes, including lower in-hospital mortality. However, it does not impact long-term survival rates compared to dual therapy.
Area of Science:
- Cardiology
- Pharmacology
- Nephrology
Background:
- Unresolved question regarding triple vs. dual antiplatelet therapy for acute myocardial infarction (AMI) patients with renal dysfunction undergoing percutaneous coronary intervention (PCI).
- Renal dysfunction is a significant complicating factor in AMI management.
Purpose of the Study:
- To compare the efficacy and safety of triple antiplatelet therapy (aspirin, clopidogrel, and cilostazol) versus dual antiplatelet therapy (aspirin and clopidogrel) in AMI patients with renal dysfunction.
- To evaluate major adverse cardiac events (MACE) and mortality rates between the two treatment groups.
Main Methods:
- Retrospective analysis of 2,288 AMI patients with renal dysfunction (glomerular filtration rate <60ml/min·1.73m(2)) from the Korea Acute Myocardial Infarction Registry (KAMIR).
- Patients were divided into dual antiplatelet therapy (n=1,587) and triple antiplatelet therapy (n=701) groups.
- Comparison of in-hospital mortality, major bleeding events, and MACE at 1 month and 1 year.
Main Results:
- Triple therapy group showed similar major bleeding events compared to dual therapy.
- Triple therapy group had significantly lower in-hospital mortality.
- The 1-month MACE rate was significantly lower in the triple therapy group (11.1%) versus the dual therapy group (16.3%), primarily due to reduced mortality.
- No significant difference in MACE rate at 1 year or MACE-free survival time between the groups.
Conclusions:
- Triple antiplatelet therapy offers a favorable impact on in-hospital and short-term MACE in AMI patients with renal dysfunction.
- Long-term MACE-free survival is not significantly improved with triple antiplatelet therapy in this patient population.
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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