Cilostazol-based triple versus potent P2Y12 inhibitor-based dual antiplatelet therapy in patients with acute myocardial infarction undergoing percutaneous coronary intervention

Other Korea Acute Myocardial Infarction Registry (KAMIR) investigators

Research output: Contribution to journalArticlepeer-review

8 Citations (Scopus)

Abstract

Although potent P2Y12 inhibitor-based dual antiplatelet therapy (DAPT) has replaced clopidogrel-based therapy as the standard treatment in patients with acute myocardial infarction (AMI), there is a concern about the risk of bleeding in East Asian patients. We compared the efficacy and safety of cilostazol-based triple antiplatelet therapy (TAT) with potent P2Y12 inhibitor-based DAPT in Korean patients. A total of 4152 AMI patients who underwent percutaneous coronary intervention (PCI) in the Korea Acute Myocardial Infarction Registry were analyzed retrospectively. Patients were divided into two groups: the TAT group (aspirin + clopidogrel + cilostazol, n = 3161) and the potent DAPT group (aspirin + potent P2Y12 inhibitors [ticagrelor or prasugrel], n = 991). Major clinical outcomes at 30 days and 2 years were compared between the two groups using propensity score matching (PSM) analysis. After PSM (869 pairs), there were no significant differences between the two groups in the incidence of total death, cardiac death, myocardial infarction (MI), target vessel revascularization, stent thrombosis, and stroke at 30 days and 2 years. However, the Thrombolysis in Myocardial Infarction (TIMI) major or minor bleeding rates were significantly lower in the TAT group compared with the potent DAPT group at 2 years (6.4% vs. 3.6%, p = 0.006). In Korean AMI patients undergoing PCI, TAT with cilostazol was associated with lower bleeding than the potent P2Y12 inhibitor-based DAPT without increased ischemic risk. These results could provide a rationale for the use of TAT in East Asian AMI patients.

Original languageEnglish
Pages (from-to)1181-1192
Number of pages12
JournalHeart and Vessels
Volume35
Issue number9
DOIs
Publication statusPublished - 2020 Sept 1
Externally publishedYes

Bibliographical note

Funding Information:
This research was supported by a fund (#2016-ER6304-02) by the Research of Korea Centers for Disease Control and Prevention and Cardiovascular Intervention Research Institute Grant (#2019-CIRI001). This study was supported by the Korean Circulation Society (KCS) to commemorate the 50th Anniversary of KCS.

Funding Information:
This research was supported by a fund (#2016-ER6304-02) by the Research of Korea Centers for Disease Control and Prevention and Cardiovascular Intervention Research Institute Grant (#2019-CIRI001). This study was supported by the Korean Circulation Society (KCS) to commemorate the 50th Anniversary of KCS. The KAMIR study group of the KSC was as follows: Myung Ho Jeong, Chonnam National University Hospital, Gwangju; Yong Hoon Kim, Kangwon National University School of Medicine, Chuncheon; Young Jo Kim, Yeungnam University Hospital, Daegu; Chong Jin Kim, East West Neo Medical Center, Seoul; Myeong Chan Cho, Chungbuk National University Hospital, Chungju; Youngkeun Ahn, Chonnam National University Hospital, Gwangju; Jong Hyun Kim, Hanseo Hospital, Busan; Shung Chull Chae, Kyungbook National University Hospital, Daegu; Seung Ho Hur, Keimyung University Dongsan Medical Center, Daegu; In Whan Seong, Chungnam National University Hospital, Daejeon; Taek Jong Hong, Pusan National University Hospital, Busan; Dong Hoon Choi, Yonsei Cardiovascular Center, Seoul; Jei Keon Chae, Chonbuk National University Hospital, Jeonju; Jae Young Rhew, Presbyterian Medical Center, Jeonju; Doo Il Kim, Inje University Busan Paik Hospital, Busan; In Ho Chae, Seoul National University Bundang Hospital, Seoul; Jung Han Yoon, Wonju Severance Christian Hospital, Wonju; Bon Kwon Koo, Seoul National University Hospital, Seoul; Byung Ok Kim, Inje University Sanggye Paik Hospital, Seoul; Myoung Yong Lee, Dankook University Hospital, Cheonan; Kee Sik Kim, Daegu Catholic University Medical Center, Daegu; Jin Yong Hwang, Gyeongsang National University Hospital, Jinju; Seok Kyu Oh, Wonkwang University Hospital, Iksan; Nae Hee Lee, Soon Chun Hyang University Hospital, Bucheon; Kyoung Tae Jeong, Eulji University Hospital, Daejeon; Seung Jea Tahk, Ajou University Hospital, Suwon; Jang Ho Bae, Konyang University Hospital, Daejeon; Seung-Woon Rha, Korea University Guro Hospital, Seoul; Keum Soo Park, Inha University Hospital, Incheon; Kyoo Rok Han, Hallym University Kangdong Medical Center, Seoul; Tae Hoon Ahn, Gachon University Gil Medical Center, Incheon; Moo Hyun Kim, Dong-A University Hospital, Busan; Joo Young Yang, National Health Insurance Service Ilsan Hospital, Goyang; Chong Yun Rhim, Hallym University Medical Center, Seoul; Hyeon Cheol Gwon, Samsung Medical Center, Seoul; Seong Wook Park, Asan Medical Center, Seoul; Young Youp Koh, Chosun University Hospital, Gwangju; Seung Jae Joo, Jeju National University Hospital, Jeju; Soo Joong Kim, Kyunghee University Medical Center, Seoul; Dong Kyu Jin, Soon Chun Hyang University Hospital, Cheonan; Jin Man Cho, Kyunghee University Hospital, Seoul; Wook Sung Chung, Catholic University Hospital, Seoul; Yang Soo Jang, Yonsei Cardiovascular Center, Seoul; Jeong Gwan Cho, Chonnam National University Hospital, Gwangju; Ki Bae Seung, Catholic University Hospital, Seoul; and Seung Jung Park, Asan Medical Center, Seoul.

Publisher Copyright:
© 2020, Springer Japan KK, part of Springer Nature.

Keywords

  • Acute myocardial infarction
  • Antiplatelet therapy
  • Cilostazol
  • Percutaneous coronary intervention

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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