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Triple Antiplatelet Therapy with Cilostazol and Favorable Early Clinical Outcomes after Acute Myocardial Infarction Compared to Dual Antiplatelet Therapy with Standard or Potent P2Y12 Inhibitors

Current guidelines for the management of acute myocardial infarction (AMI) recommend potent P2Y12 inhibitors rather than clopidogrel to prevent ischemic events. However, their ischemic benefits are offset by an increased major bleeding risk. We compared the efficacy and safety of triple antiplatelet...

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Autores principales: Byun, Sungwook, Lee, Su Nam, Lim, Sungmin, Choo, Eun Ho, Choi, Ik Jun, Kim, Chan Joon, Moon, Donggyu, Park, Mahn-Won, Park, Chul Soo, Ahn, Youngkeun, Jeong, Myung-Ho, Chang, Kiyuk
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9693255/
https://www.ncbi.nlm.nih.gov/pubmed/36431333
http://dx.doi.org/10.3390/jcm11226856
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author Byun, Sungwook
Lee, Su Nam
Lim, Sungmin
Choo, Eun Ho
Choi, Ik Jun
Kim, Chan Joon
Moon, Donggyu
Park, Mahn-Won
Park, Chul Soo
Ahn, Youngkeun
Jeong, Myung-Ho
Chang, Kiyuk
author_facet Byun, Sungwook
Lee, Su Nam
Lim, Sungmin
Choo, Eun Ho
Choi, Ik Jun
Kim, Chan Joon
Moon, Donggyu
Park, Mahn-Won
Park, Chul Soo
Ahn, Youngkeun
Jeong, Myung-Ho
Chang, Kiyuk
author_sort Byun, Sungwook
collection PubMed
description Current guidelines for the management of acute myocardial infarction (AMI) recommend potent P2Y12 inhibitors rather than clopidogrel to prevent ischemic events. However, their ischemic benefits are offset by an increased major bleeding risk. We compared the efficacy and safety of triple antiplatelet therapy with cilostazol in the first month after AMI. This study investigated 16,643 AMI patients who received percutaneous coronary intervention (PCI) with drug-eluting stents (DES) in nationwide, real-world, multicenter registries in Korea. Patients were divided into DAPT (aspirin and clopidogrel, n = 11,285), Triple (aspirin, clopidogrel and cilostazol, n = 2547), and Potent (aspirin and ticagrelor/prasugrel, n = 2811) groups. The primary outcomes were net adverse clinical events (NACE), a composite of death from any cause, myocardial infarction (MI), stroke, and TIMI major bleeding one month after AMI. After adjusting for covariates, there were no statistically significant differences in the risk of death from any cause, MI, or stroke between the three groups. However, the risk of TIMI major bleeding was significantly greater in the Potent group than in the DAPT and Triple groups (p < 0.001). Accordingly, NACE was significantly higher in the DAPT (HR 1.265; 95% CI 1.006–1.591, p = 0.044) and Potent groups (HR 1.515; 95% CI 1.142–2.011, p = 0.004) than in the Triple group. Triple antiplatelet therapy with cilostazol was associated with an improved net clinical outcome in the first month after AMI without increasing the risk of bleeding compared to potent or standard P2Y12 inhibitor-based DAPT.
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spelling pubmed-96932552022-11-26 Triple Antiplatelet Therapy with Cilostazol and Favorable Early Clinical Outcomes after Acute Myocardial Infarction Compared to Dual Antiplatelet Therapy with Standard or Potent P2Y12 Inhibitors Byun, Sungwook Lee, Su Nam Lim, Sungmin Choo, Eun Ho Choi, Ik Jun Kim, Chan Joon Moon, Donggyu Park, Mahn-Won Park, Chul Soo Ahn, Youngkeun Jeong, Myung-Ho Chang, Kiyuk J Clin Med Article Current guidelines for the management of acute myocardial infarction (AMI) recommend potent P2Y12 inhibitors rather than clopidogrel to prevent ischemic events. However, their ischemic benefits are offset by an increased major bleeding risk. We compared the efficacy and safety of triple antiplatelet therapy with cilostazol in the first month after AMI. This study investigated 16,643 AMI patients who received percutaneous coronary intervention (PCI) with drug-eluting stents (DES) in nationwide, real-world, multicenter registries in Korea. Patients were divided into DAPT (aspirin and clopidogrel, n = 11,285), Triple (aspirin, clopidogrel and cilostazol, n = 2547), and Potent (aspirin and ticagrelor/prasugrel, n = 2811) groups. The primary outcomes were net adverse clinical events (NACE), a composite of death from any cause, myocardial infarction (MI), stroke, and TIMI major bleeding one month after AMI. After adjusting for covariates, there were no statistically significant differences in the risk of death from any cause, MI, or stroke between the three groups. However, the risk of TIMI major bleeding was significantly greater in the Potent group than in the DAPT and Triple groups (p < 0.001). Accordingly, NACE was significantly higher in the DAPT (HR 1.265; 95% CI 1.006–1.591, p = 0.044) and Potent groups (HR 1.515; 95% CI 1.142–2.011, p = 0.004) than in the Triple group. Triple antiplatelet therapy with cilostazol was associated with an improved net clinical outcome in the first month after AMI without increasing the risk of bleeding compared to potent or standard P2Y12 inhibitor-based DAPT. MDPI 2022-11-21 /pmc/articles/PMC9693255/ /pubmed/36431333 http://dx.doi.org/10.3390/jcm11226856 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Byun, Sungwook
Lee, Su Nam
Lim, Sungmin
Choo, Eun Ho
Choi, Ik Jun
Kim, Chan Joon
Moon, Donggyu
Park, Mahn-Won
Park, Chul Soo
Ahn, Youngkeun
Jeong, Myung-Ho
Chang, Kiyuk
Triple Antiplatelet Therapy with Cilostazol and Favorable Early Clinical Outcomes after Acute Myocardial Infarction Compared to Dual Antiplatelet Therapy with Standard or Potent P2Y12 Inhibitors
title Triple Antiplatelet Therapy with Cilostazol and Favorable Early Clinical Outcomes after Acute Myocardial Infarction Compared to Dual Antiplatelet Therapy with Standard or Potent P2Y12 Inhibitors
title_full Triple Antiplatelet Therapy with Cilostazol and Favorable Early Clinical Outcomes after Acute Myocardial Infarction Compared to Dual Antiplatelet Therapy with Standard or Potent P2Y12 Inhibitors
title_fullStr Triple Antiplatelet Therapy with Cilostazol and Favorable Early Clinical Outcomes after Acute Myocardial Infarction Compared to Dual Antiplatelet Therapy with Standard or Potent P2Y12 Inhibitors
title_full_unstemmed Triple Antiplatelet Therapy with Cilostazol and Favorable Early Clinical Outcomes after Acute Myocardial Infarction Compared to Dual Antiplatelet Therapy with Standard or Potent P2Y12 Inhibitors
title_short Triple Antiplatelet Therapy with Cilostazol and Favorable Early Clinical Outcomes after Acute Myocardial Infarction Compared to Dual Antiplatelet Therapy with Standard or Potent P2Y12 Inhibitors
title_sort triple antiplatelet therapy with cilostazol and favorable early clinical outcomes after acute myocardial infarction compared to dual antiplatelet therapy with standard or potent p2y12 inhibitors
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9693255/
https://www.ncbi.nlm.nih.gov/pubmed/36431333
http://dx.doi.org/10.3390/jcm11226856
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