The clinical outcomes of triple antiplatelet therapy versus dual antiplatelet therapy for high-risk patients after coronary stent implantation: a meta-analysis of 11 clinical trials and 9,553 patients

Abstract

BackgroundThe optimal antiplatelet regimen after in-coronary intervention among patients presenting with complex coronary artery lesions or acute coronary syndrome (ACS) has remained unclear. This study sought to evaluate the clinical outcomes of triple antiplatelet treatment (TAPT) (cilostazol added to aspirin plus clopidogrel) in these patients.MethodsThe PubMed, EMBASE, MEDLINE, and other Internet sources were searched for relevant articles. The primary end point was major adverse cardiac events (MACE), including all-cause mortality, myocardial infarction, and target vessel revascularization. The incidence of definite/probable stent thrombosis and bleeding were analyzed as the safety end points.ResultsEleven clinical trials involving 9,553 patients were analyzed. The risk of MACE was significantly decreased following TAPT after stent implantation in the ACS subgroup (odds ratio [OR]: 0.72; 95% confidence interval [CI]: 0.61–0.85; P<0.001), which might mainly result from the lower risk of all-cause mortality in this subset (OR: 0.62; 95% CI: 0.48–0.80; P<0.001). The risk of bleeding was not increased with respect to TAPT.ConclusionTAPT after stent implantation was associated with feasible benefits on reducing the risk of MACE, especially on reducing the incidence of all-cause mortality among patients suffering from ACS, without higher incidence of bleeding. Larger and more powerful randomized trials are still warranted to prove the superiority of TAPT for such patients.

<p>Comparisons between ticagrelor and clopidogrel following percutaneous coronary intervention in patients with acute coronary syndrome: a comprehensive meta-analysis</p>

“…We previously performed a meta-analysis to evaluate the efficacy and safety of TAPT for patients with complex coronary lesions or suffering from ACS. The incidence of composite major adverse cardiac events (including all-cause mortality, MI, and target vessel revascularization) was lower in patients receiving TAPT rather than routine DAPT 29. In this present study, only a tendency toward reduction in the risk of MACCEs (composite of cardiovascular death, MI, and stroke) was observed, which might have resulted from the significantly reduced occurrence of cardiovascular death.…”

Association Between Helicobacter Pylori Infection and Long-term Outcome in Patients with Drug-eluting Stent Implantation

“…Significant correlation of Hp infection with ACS and cardiac syndrome X has ever been demonstrated in previous studies7891011121314151617, but contrary results have also been reported in other researches181920. Hp is a pathogen that can cause persistent infection even be life-long, and antibodies could be persistently generated.…”

More, More, More: Reducing Thrombosis in Acute Coronary Syndromes Beyond Dual Antiplatelet Therapy—Current Data and Future Directions

“…6 A meta-analysis of randomized and observational studies (n=11) of high-risk ACS patients undergoing PCI, using DerSimonian and Laird principles, showed that TT reduced all-cause mortality compared with DAPT (odds ratio [OR]: 0.72; 95% CI, 0.61-0.85; P<0.001) without an effect on MI (OR: 0.97; 95% CI, 0.63-1.51; P=0.901), target vessel revascularization (TVR; OR: 0.90; 95% CI 0.65-1.23; P=0.491), stroke (OR: 0.63; 95% CI, 0.32-1.21; P=0.163), or bleeding (OR: 1.07; 95% CI, 0.60-1.90; P=0.809). 7 However, a larger meta-analysis of 19 randomized trials and registries comparing aspirin and clopidogrel against TT with cilostazol in 7464 patients with ACS undergoing PCI 8 showed that TT did not significantly reduce major adverse cardiovascular events or mortality (relative risk [RR]: 0.77; 95% CI, 0.55-1.09; P=0.15) but significantly reduced TVR (RR: 0.65; 95% CI, 0.55-0.77; P<0.00001). Cilostazol is restricted to use as a second-line agent in patients with claudication and is not currently recommended by the European Society of Cardiology (ESC) 9 or American College of Cardiology/American Heart Association (ACC/AHA) guidelines, 10,11 nor is it approved for ACS.…”