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

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 & 8 others Dong Hoon Choi, Yang Soo Jang, In Ho Chae, Chong Jin Kim, Jung Han Yoon, Wook Sung Chung, Ki Bae Seung, Seung Jung Park

Research output: Contribution to journalArticle

153 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)3207-3214
Number of pages8
JournalCirculation
Volume119
Issue number25
DOIs
Publication statusPublished - 2009 Jun 30

Fingerprint

Percutaneous Coronary Intervention
Myocardial Infarction
clopidogrel
Drug-Eluting Stents
Odds Ratio
Confidence Intervals
Therapeutics
Aspirin
Incidence
Hospital Mortality
Registries
Hemorrhage
ST Elevation Myocardial Infarction

Keywords

  • Cilostazol
  • Myocardial infarction
  • Platelets
  • Thrombosis

ASJC Scopus subject areas

  • Physiology (medical)
  • Cardiology and Cardiovascular Medicine

Cite this

Triple versus dual antiplatelet therapy in patients with acute st-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. / Chen, Kang Yin; Rha, Seung-Woon; Li, Yong Jian; Poddar, Kanhaiya L.; Jin, Zhe; Minami, Yoshiyasu; Wang, Lin; Kim, Eung Ju; Park, Chang Gyu; Seo, Hong Seog; Oh, Dong Joo; Jeong, Myung Ho; Ahn, Young Keun; Hong, Taek Jong; Kim, Young Jo; Hur, Seung Ho; Seong, In Whan; Chae, Jei Keon; Cho, Myeong Chan; Bae, Jang Ho; Choi, Dong Hoon; Jang, Yang Soo; Chae, In Ho; Kim, Chong Jin; Yoon, Jung Han; Chung, Wook Sung; Seung, Ki Bae; Park, Seung Jung.

In: Circulation, Vol. 119, No. 25, 30.06.2009, p. 3207-3214.

Research output: Contribution to journalArticle

Chen, KY, Rha, S-W, Li, YJ, Poddar, KL, Jin, Z, Minami, Y, Wang, L, Kim, EJ, Park, CG, Seo, HS, Oh, DJ, Jeong, MH, Ahn, YK, Hong, TJ, Kim, YJ, Hur, SH, Seong, IW, Chae, JK, Cho, MC, Bae, JH, Choi, DH, Jang, YS, Chae, IH, Kim, CJ, Yoon, JH, Chung, WS, Seung, KB & Park, SJ 2009, 'Triple versus dual antiplatelet therapy in patients with acute st-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention', Circulation, vol. 119, no. 25, pp. 3207-3214. https://doi.org/10.1161/CIRCULATIONAHA.108.822791
Chen, Kang Yin ; Rha, Seung-Woon ; Li, Yong Jian ; Poddar, Kanhaiya L. ; Jin, Zhe ; Minami, Yoshiyasu ; Wang, Lin ; Kim, Eung Ju ; Park, Chang Gyu ; Seo, Hong Seog ; Oh, Dong Joo ; Jeong, Myung Ho ; Ahn, Young Keun ; Hong, Taek Jong ; Kim, Young Jo ; Hur, Seung Ho ; Seong, In Whan ; Chae, Jei Keon ; Cho, Myeong Chan ; Bae, Jang Ho ; Choi, Dong Hoon ; Jang, Yang Soo ; Chae, In Ho ; Kim, Chong Jin ; Yoon, Jung Han ; Chung, Wook Sung ; Seung, Ki Bae ; Park, Seung Jung. / Triple versus dual antiplatelet therapy in patients with acute st-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. In: Circulation. 2009 ; Vol. 119, No. 25. pp. 3207-3214.
@article{bf0cf4ad77504aef8f6b0532f306410d,
title = "Triple versus dual antiplatelet therapy in patients with acute st-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention",
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.",
keywords = "Cilostazol, Myocardial infarction, Platelets, Thrombosis",
author = "Chen, {Kang Yin} and Seung-Woon Rha and Li, {Yong Jian} and Poddar, {Kanhaiya L.} and Zhe Jin and Yoshiyasu Minami and Lin Wang and Kim, {Eung Ju} and Park, {Chang Gyu} and Seo, {Hong Seog} and Oh, {Dong Joo} and Jeong, {Myung Ho} and Ahn, {Young Keun} and Hong, {Taek Jong} and Kim, {Young Jo} and Hur, {Seung Ho} and Seong, {In Whan} and Chae, {Jei Keon} and Cho, {Myeong Chan} and Bae, {Jang Ho} and Choi, {Dong Hoon} and Jang, {Yang Soo} and Chae, {In Ho} and Kim, {Chong Jin} and Yoon, {Jung Han} and Chung, {Wook Sung} and Seung, {Ki Bae} and Park, {Seung Jung}",
year = "2009",
month = "6",
day = "30",
doi = "10.1161/CIRCULATIONAHA.108.822791",
language = "English",
volume = "119",
pages = "3207--3214",
journal = "Circulation",
issn = "0009-7322",
publisher = "Lippincott Williams and Wilkins",
number = "25",

}

TY - JOUR

T1 - Triple versus dual antiplatelet therapy in patients with acute st-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention

AU - Chen, Kang Yin

AU - Rha, Seung-Woon

AU - Li, Yong Jian

AU - Poddar, Kanhaiya L.

AU - Jin, Zhe

AU - Minami, Yoshiyasu

AU - Wang, Lin

AU - Kim, Eung Ju

AU - Park, Chang Gyu

AU - Seo, Hong Seog

AU - Oh, Dong Joo

AU - Jeong, Myung Ho

AU - Ahn, Young Keun

AU - Hong, Taek Jong

AU - Kim, Young Jo

AU - Hur, Seung Ho

AU - Seong, In Whan

AU - Chae, Jei Keon

AU - Cho, Myeong Chan

AU - Bae, Jang Ho

AU - Choi, Dong Hoon

AU - Jang, Yang Soo

AU - Chae, In Ho

AU - Kim, Chong Jin

AU - Yoon, Jung Han

AU - Chung, Wook Sung

AU - Seung, Ki Bae

AU - Park, Seung Jung

PY - 2009/6/30

Y1 - 2009/6/30

N2 - 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.

AB - 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.

KW - Cilostazol

KW - Myocardial infarction

KW - Platelets

KW - Thrombosis

UR - http://www.scopus.com/inward/record.url?scp=67650761110&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=67650761110&partnerID=8YFLogxK

U2 - 10.1161/CIRCULATIONAHA.108.822791

DO - 10.1161/CIRCULATIONAHA.108.822791

M3 - Article

VL - 119

SP - 3207

EP - 3214

JO - Circulation

JF - Circulation

SN - 0009-7322

IS - 25

ER -