The Heart Center of Chonnam National University Hospital, Cardiovascular Research Institute of Chonnam National University, Gwangju, Korea.
Korean Circ J. 2009 May;39(5):190-7. doi: 10.4070/kcj.2009.39.5.190. Epub 2009 May 28.
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).
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).
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}.
Triple anti-platelet therapy is safe and efficacious, and it prevents TLR in patients with AMI, especially those with complex lesions and non-STEMIs.
已知三联抗血小板治疗可预防药物洗脱支架（DES）植入后的再狭窄。然而，关于急性心肌梗死（AMI）患者三联抗血小板治疗的疗效数据很少。
我们分析了 2005 年 11 月至 2008 年 4 月期间接受 DES 植入的 528 例连续 AMI 患者。我们比较了三联抗血小板治疗组（I 组，n=413：西洛他唑联合阿司匹林和氯吡格雷至少 1 个月）和双联抗血小板治疗组（II 组，n=115：阿司匹林和氯吡格雷）的临床结局。
两组患者的基线特征无显著差异。然而，I 组中 ST 段抬高型心肌梗死（STEMI）和使用 TAXUS（R）支架更为常见（70.9% vs. 55.7%，p=0.002；83.5% vs. 73.0%，p=0.011）。I 组的心脏死亡、6 个月靶病变血运重建（TLR）和主要不良心脏和脑血管事件（MACCE）发生率均低于 II 组（1.7% vs. 5.7%，p=0.022；5.7% vs. 11.5%，0.035；7.9% vs. 16.0%，p=0.011）。亚组分析显示，在 ACC/AHA B2 或 C 级病变和非 STEMI 患者中，I 组 6 个月 TLR 的发生率较低（6.0% vs. 14.9%，p=0.012；4.3% vs. 19.1%，p=0.002）。两组出血并发症发生率无差异。多因素分析显示，Killip III 或 IV 级和三联抗血小板治疗是 6 个月 MACCE 的独立预测因素（风险比[HR]=3.382；95%置信区间[CI]=1.384-8.262，HR=0.436；95%CI=0.203-0.933）。
三联抗血小板治疗安全有效，可预防 AMI 患者的 TLR，特别是复杂病变和非 STEMI 患者。
