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(Circulation. 2009;119:3207-3214.)
© 2009 American Heart Association, Inc.

Interventional Cardiology

Triple Versus Dual Antiplatelet Therapy in Patients With Acute ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

Kang-Yin Chen, MD; Seung-Woon Rha, MD; Yong-Jian Li, MD; Kanhaiya L. Poddar, MBBS; Zhe Jin, MD; Yoshiyasu Minami, MD; Lin Wang, MD; Eung Ju Kim, MD; Chang Gyu Park, MD; Hong Seog Seo, MD; Dong Joo Oh, MD; Myung Ho Jeong, MD; Young Keun Ahn, MD; Taek Jong Hong, MD; Young Jo Kim, MD; Seung Ho Hur, MD; In Whan Seong, MD; Jei Keon Chae, MD; Myeong Chan Cho, MD; Jang Ho Bae, MD; Dong Hoon Choi, MD; Yang Soo Jang, MD; In Ho Chae, MD; Chong Jin Kim, MD; Jung Han Yoon, MD; Wook Sung Chung, MD; Ki Bae Seung, MD; Seung Jung Park, MD, for the Korea Acute Myocardial Infarction Registry Investigators

From the Korea University Guro Hospital, Seoul, Korea.

Correspondence to Seung-Woon Rha, MD, PhD, FACC, FAHA, FESC, FSCAI, Cardiovascular Center, Korea University Guro Hospital, 80, Guro-dong, Guro-gu, Seoul, 152–703, Korea. E-mail swrha617{at}yahoo.co.kr

Received September 18, 2008; accepted April 21, 2009.

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.

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