Efficacy of Triple Anti-Platelet Therapy Including Cilostazol in Acute Myocardial Infarction Patients Undergoing Drug-Eluting Stent Implantation.
10.4070/kcj.2009.39.5.190
- Author:
Keun Ho PARK
1
;
Myung Ho JEONG
;
Min Goo LEE
;
Jum Suk KO
;
Shin Eun LEE
;
Won Yu KANG
;
Soo Hyun KIM
;
Doo Sun SIM
;
Nam Sik YOON
;
Hyun Ju YOUN
;
Young Joon HONG
;
Hyung Wook PARK
;
Ju Han KIM
;
Youngkeun AHN
;
Jeong Gwan CHO
;
Jong Chun PARK
;
Jung Chaee KANG
Author Information
1. The Heart Center of Chonnam National University Hospital, Cardiovascular Research Institute of Chonnam National University, Gwangju, Korea. myungho@chollian.net
- Publication Type:Original Article
- Keywords:
Platelets;
Drug-eluting stents;
Myocardial infarction
- MeSH:
Aspirin;
Blood Platelets;
Death;
Drug-Eluting Stents;
Heart;
Hemorrhage;
Humans;
Incidence;
Multivariate Analysis;
Myocardial Infarction;
Stents;
Tetrazoles;
Ticlopidine
- From:Korean Circulation Journal
2009;39(5):190-197
- CountryRepublic of Korea
- Language:English
-
Abstract:
BACKGROUND AND OBJECTIVES: Triple anti-platelet therapy is known to prevent restenosis after drug-eluting stent (DES) implantation. However, there is little available data concerning the efficacy of triple anti-platelet therapy for acute myocardial infarction (AMI). SUBJECTS AND METHODS: We analyzed 528 consecutive patients with AMI undergoing DES implantation between Nov 2005 and Apr 2008. We compared clinical outcomes in the triple anti-platelet therapy (group I, n=413: cilostazol combined with aspirin and clopidogrel for at least one month) and dual antiplatelet therapy groups (group II, n=115: aspirin and clopidogrel). RESULTS: There were no significant differences in baseline characteristics. However, ST elevation myocardial infarction (STEMI) and use of TAXUS(R) stents were more common (70.9% vs. 55.7%, p=0.002; 83.5% vs. 73.0%, p=0.011) in Group I. Group I had lower incidences of cardiac death, 6-month target lesion revascularization (TLR), and major adverse cardiac and cerebrovascular events (MACCE) compared to Group II (1.7% vs. 5.7%, p=0.022; 5.7% vs. 11.5%, 0.035; 7.9% vs. 16.0%, p=0.011). On subgroup analysis, the incidence of 6-month TLR was lower among patients with American College of Cardiology/American Heart Association (ACC/AHA) B2 or C lesions and non-STEMI (6.0% vs. 14.9%, p=0.012; 4.3% vs. 19.1%, p=0.002) in Group I compared to those in Group II. The rates of bleeding complications were no different between the two groups. On multivariate analysis, Killip III or IV and triple anti-platelet therapy were independent predictors of 6-month MACCE {hazard ratio (HR)=3.382; 95% confidence interval (CI)=1.384-8.262, HR=0.436; 95% CI=0.203-0.933}. CONCLUSION:Triple anti-platelet therapy is safe and efficacious, and it prevents TLR in patients with AMI, especially those with complex lesions and non-STEMIs.
