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Triple versus dual antiplatelet therapy in patients with acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention

Authors
 Kang-Yin Chen  ;  Seung-Woon Rha  ;  Yong-Jian Li  ;  Kanhaiya L. Poddar  ;  Zhe Jin  ;  Yoshiyasu Minami  ;  Lin Wang  ;  Eung Ju Kim  ;  Chang Gyu Park  ;  Hong Seog Seo  ;  Dong Joo Oh  ;  Myung Ho Jeong  ;  Young Keun Ahn  ;  Taek Jong Hong  ;  Young Jo Kim  ;  Seung Ho Hur  ;  In Whan Seong  ;  Jei Keon Chae  ;  Myeong Chan Cho  ;  Jang Ho Bae  ;  Dong Hoon Choi  ;  Yang Soo Jang  ;  In Ho Chae  ;  Chong Jin Kim  ;  Jung Han Yoon  ;  Wook Sung Chung  ;  Ki Bae Seung  ;  Seung Jung Park 
Citation
 CIRCULATION, Vol.119(25) : 3207-3214, 2009 
Journal Title
CIRCULATION
ISSN
 0009-7322 
Issue Date
2009
MeSH
Aged ; Angioplasty, Balloon, Coronary* ; Aspirin/therapeutic use ; Combined Modality Therapy ; Coronary Thrombosis/prevention & control* ; Drug Therapy, Combination ; Drug-Eluting Stents* ; Electrocardiography ; Female ; Humans ; Male ; Middle Aged ; Myocardial Infarction/diagnosis ; Myocardial Infarction/drug therapy* ; Myocardial Infarction/mortality* ; Platelet Aggregation Inhibitors/therapeutic use* ; Proportional Hazards Models ; Registries ; Retrospective Studies ; Tetrazoles/therapeutic use ; Ticlopidine/analogs & derivatives ; Ticlopidine/therapeutic use
Abstract
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.
Files in This Item:
T200901521.pdf Download
DOI
10.1161/CIRCULATIONAHA.108.822791
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Jang, Yang Soo(장양수) ORCID logo https://orcid.org/0000-0002-2169-3112
Choi, Dong Hoon(최동훈) ORCID logo https://orcid.org/0000-0002-2009-9760
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/103966
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