Document Detail

Triple versus dual antiplatelet therapy in patients with acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention.
MedLine Citation:
PMID:  19528339     Owner:  NLM     Status:  MEDLINE    
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.
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;
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Publication Detail:
Type:  Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't     Date:  2009-06-15
Journal Detail:
Title:  Circulation     Volume:  119     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2009 Jun 
Date Detail:
Created Date:  2009-06-30     Completed Date:  2009-07-22     Revised Date:  2013-05-30    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  3207-14     Citation Subset:  AIM; IM    
Korea University Guro Hospital, Seoul, Korea.
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MeSH Terms
Angioplasty, Balloon, Coronary*
Aspirin / therapeutic use
Combined Modality Therapy
Coronary Thrombosis / prevention & control*
Drug Therapy, Combination
Drug-Eluting Stents*
Middle Aged
Myocardial Infarction / diagnosis,  drug therapy*,  mortality*
Platelet Aggregation Inhibitors / therapeutic use*
Proportional Hazards Models
Retrospective Studies
Tetrazoles / therapeutic use
Ticlopidine / analogs & derivatives,  therapeutic use
Reg. No./Substance:
0/Platelet Aggregation Inhibitors; 0/Tetrazoles; 50-78-2/Aspirin; 55142-85-3/Ticlopidine; A74586SNO7/clopidogrel; N7Z035406B/cilostazol
Myung Ho Jeong / ; Young Jo Kim / ; Chong Jin Kim / ; Myeong Chan Cho / ; Young Keun Ahn / ; Jong Hyun Kim / ; Shung Chull Chae / ; Seung Ho Hur / ; In Whan Seong / ; Taek Jong Hong / ; Dong Hoon Choi / ; Jei Keon Chae / ; Jae Young Rhew / ; Doo Il Kim / ; In Ho Chae / ; Jung Han Yoon / ; Bon Kwon Koo / ; Byung Ok Kim / ; Myoung Yong Lee / ; Kee Sik Kim / ; Jin Yong Hwang / ; Seok Kyu Oh / ; Nae Hee Lee / ; Kyoung Tae Jeong / ; Seung Jea Tahk / ; Jang Ho Bae / ; Seung Woon Rha / ; Keum Soo Park / ; Kyoo Rok Han / ; Tae Hoon Ahn / ; Moo Hyun Kim / ; Ju Young Yang / ; Chong Yun Rhim / ; Hyeon Cheol Gwon / ; Seong Wook Park / ; Young Youp Koh / ; Seung Jae Joo / ; Soo Joong Kim / ; Dong Kyu Jin / ; Jin Man Cho / ; Jeong Gwan Cho / ; Wook Sung Chung / ; Yang Soo Jang / ; Ki Bae Seung / ; Seung Jung Park /
Comment In:
Circulation. 2010 Feb 23;121(7):e43; author reply e44-5   [PMID:  20177003 ]
Circulation. 2009 Jun 30;119(25):3168-70   [PMID:  19528332 ]

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