Triple versus dual antiplatelet therapy in patients with acute myocardial infarction undergoing percutaneous coronary intervention

초록

Background: Whether the safety and efficacy of triple antiplatelet strategy is superior or similar to the dual antiplatelet strategy in patients (pts) with acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI) is still unclear. Methods: A total of 4,892 AMI pts undergoing PCI were randomly assigned to receive either dual antiplatelet therapy (aspirin plus clopidogrel, Dual group, n=2,974) or triple antiplatelet therapy (aspirin plus clopidogrel plus cilostazol, Triple group, n=1,918). All major adverse cardiac events (All MACE) included total death, revascularization, and myocardial re-infarction. The bleeding complications and clinical outcomes of in-hospital, 1 and 6 months were compared between the two groups. Results: The baseline characteristics were similar between the two groups. The early mortality and revascularization rate were lower in Triple group up to one month and all MACE was significantly lower up to 6 months. Interestingly, Triple group also had a significantly lower in-hospital major bleeding (Table). This result might be due to the Triple group had less history of peptic ulcer disease (0.4% vs. 0.9%, P=0.034). Conclusions: Triple antiplatelet therapy appears to be superior in preventing the MACE without increasing the major bleeding events in pts with AMI undergoing PCI compared with the conventional dual antiplatelet therapy.