Efficacy of Triple Anti-Platelet Therapy Including Cilostazol in Acute Myocardial Infarction Patients Undergoing Drug-Eluting Stent Implantation

BACKGROUND AND OBJECTIVES 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). SUBJECTS AND METHODS 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). RESULTS 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}. CONCLUSION Triple anti-platelet therapy is safe and efficacious, and it prevents TLR in patients with AMI, especially those with complex lesions and non-STEMIs.