Abstract 14779: Triple Versus Dual Antiplatelet Therapy in Acute Myocardial Infarction in Relation to Renal Function
Background: Chronic kidney disease (CKD) is a strong risk factor for cardiovascular events, and there are consistence evidences about worse short- and long-term outcomes in CKD patients with acute myocardial infarction. The aim of this study was to evaluate the effects and safety of triple antiplatelet therapy (aspirin plus clopidogrel plus cilostazol) in CKD patients with ST-elevation myocardial infarction (STEMI) compared with dual antiplatelet therapy (aspirin plus clopidogrel).
Methods and results: Among over 21,000 patients in Korean Acute Myocardial Infarction Registry (KAMIR) data, 5,138 STEMI patients who underwent successful primary percutaneous coronary intervention with drug-eluting stents were enrolled in this study. They were divided by estimated creatinine clearance (eCrCl); ≥ 60 ml/min (n=3,445; dual = 2169, triple = 1276) and < 60 ml/min (n=1693; dual = 1120, triple = 573). Various major adverse cardiac events including major bleeding at 12 months were evaluated. The triple group had significantly lower incidences of total death, cardiac death, and total major adverse cardiac events than the dual group in both eCrCl groups. In group with eCrCl < 60 ml/min, triple therapy showed beneficial effect of 12-month total death in patients with older (≥65-year-old) age, worse Killip class, and culprit lesion with left anterior descending artery. In group with eCrCl ≥ 60 ml/min, triple therapy showed beneficial effect in patients with older (≥65-year-old) age, and diabetes. But bleeding complications did not showed significant difference between the 2 groups in both eCrCl groups.
Conclusion: Triple therapy is a safe and effective antiplatelet strategy in CKD patients with STMEI.
- © 2011 by American Heart Association, Inc.