Long-term effectiveness and safety of triple versus dual antiplatelet therapy after percutaneous coronary intervention for unprotected left main coronary artery disease

OBJECTIVES: We sought to compare the long-term effectiveness and safety of triple antiplatelet therapy (TAPT) versus dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) for unprotected left main coronary artery disease (uLMCAD). BACKGROUND: An additional strategy to reduce recurrent ischemia after PCI for uLMCAD is needed to improve the long-term clinical outcomes and match the efficacy of bypass surgery. METHODS: We evaluated 245 patients who underwent PCI with drug-eluting stents for uLMCA stenosis of at least 50% from the Sejong General Institute PCI database between April 2003 and December 2010. TAPT was defined as the addition of cilostazol for at least 3 months to conventional DAPT after PCI. RESULTS: A total of 124 patients received TAPT and 121 patients received DAPT. The TAPT group had a higher number of male patients, need for the two-stent technique, and Synergy between percutaneous coronary intervention with Taxus and Cardiac Surgery (SYNTAX) scores and longer stent length compared with the DAPT group. During a median 30.6 months, major adverse cardiac and cerebrovascular events (MACCE) occurred in 43 patients (17.6%): 23 (18.5%) in the TAPT group and 20 (16.5%) in the DAPT group (P=0.68). In the multivariate analysis, TAPT was not associated with a lower incidence of MACCE (hazard ratio: 0.69, 95% confidence interval: 0.34-1.43). Thrombolysis in myocardial infarction (TIMI) major and minor bleeding occurred at similar rates (5.6 vs. 3.3%, P=0.565, for TIMI major bleeding; and 14.5 vs. 14.9%, P=0.718, for TIMI minor bleeding). CONCLUSION: TAPT after drug-eluting stent implantation in patients with uLMCAD did not improve the long-term clinical outcome when compared with conventional DAPT, although it was a safe strategy.