Outcome of Triple Antiplatelet Therapy Including Cilostazol in Elderly Patients with ST-Elevation Myocardial Infarction who Underwent Primary Percutaneous Coronary Intervention: Results from the INTERSTELLAR Registry
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Compared with dual antiplatelet therapy including aspirin and clopidogrel, triple antiplatelet therapy including cilostazol has a mortality benefit in patients with ST-segment elevation myocardial infarction. However, whether the mortality benefit persists in elderly patients is not clear.
From 2007 to 2014, 1278 patients with ST-segment elevation myocardial infarction who underwent primary percutaneous coronary intervention were retrospectively analyzed. The patients were divided into four groups by age (<75 or ≥75 years; young and elderly, respectively) and antiplatelet strategy (triple or dual antiplatelet therapy). We compared the mortality rates between the triple and dual antiplatelet therapy groups.
There were 1052 (male, 85%; mean age, 56.3 ± 10.4 years) patients in the young group and 241 (male, 52.7%; mean age, 80.3 ± 4.5 years) patients in the elderly group. In the young and elderly groups, 220 (20.9%) and 28 (12.3%) patients were treated with triple antiplatelet therapy. During a 1-year follow-up period, 80 patients died (4.2% in the young group vs. 15.5% in the elderly group). Kaplan–Meier survival analysis revealed that triple antiplatelet therapy was associated with a lower mortality rate in the young group (log-rank, p = 0.005). Although there were more angiographic high-risk patients in the elderly group, similar mortality rates were reported (log-rank, p = 0.803) without increased bleeding rates (1 vs. 3.6% in the elderly group, p = 0.217).
Triple antiplatelet therapy might be a better antiplatelet regimen than dual antiplatelet therapy for patients with ST-segment elevation myocardial infarction. Although this benefit was strong in patients aged <75 years, no definite increase in major bleeding was seen for elderly patients (aged ≥75 years).
KeywordsPercutaneous Coronary Intervention Clopidogrel Elderly Group Major Adverse Cardiac Event Prasugrel
This article was written and edited by the authors, who take full responsibility for its content.
Compliance with Ethical Standards
This work was supported by the INHA UNIVERSITY Research Grant (INHA-54729). This work was supported by Grant YH16-03-16 from the Yuhan Corporation, Republic of Korea . This work was supported by the INHA UNIVERSITY Research Grant (INHA-51457) .
Conflict of interest
Ho-Jun Jang, Sang-Don Park, Hyun Woo Park, Jon Suh, Pyung Chun Oh, Jeonggeun Moon, Kyounghoon Lee, Woong Chol Kang, Sung Woo Kwon, Tae-Hoon Kim declare that they have no conflicts of interest that might be relevant to the contents of this manuscript.
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