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).Table: Clinical outcomes of study population
Variable, n (%)
Dual group(n=2,974 pts)
Triple group(n= 1,918 pts)
P value
In-hospital
Total death
89 (3.0)
34 (1.8)
0.008
Reinfarction
12 (0.4)
9 (0.5)
0.730
Revascularization
41 (1.4)
12 (0.6)
0.013
All MACE
142 (4.8)
55 (2.9)
0.001
TIMI-major bleeding
12 (0.6)
3 (0.2)
0.023
At 1 month
Total death
106 (3.7)
50 (2.7)
0.046
Reinfarction
25 (0.9)
10 (0.5)
0.175
Revascularization
71 (2.5)
26 (1.4)
0.008
All MACE
202 (7.1)
86 (4.6)
0.001
At 6 months
Total death
124 (4.3)
65 (3.5)
0.147
Reinfarction
34 (1.2)
13 (0.7)
0.097
Revascularization
150 (5.2)
75 (4.0)
0.055
All MACE
308 (10.7)
153 (8.2)
0.004
Conclusion: 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.
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