GW24-e1373 Effect and security with triple antiplatelet therapy in patients undergoing drug-eluting stents for the treatment of complex coronary lesions

Objectives To evaluate the efficacy and safety of triple antiplatelet therapy (cilostazol combined with clopidogrel and aspirin) in patients undergoing multiple drug-eluting stents (DES) implantation of complex coronary lesions. Methods Totally 128 senile patients undergoing multiple DESs implantation for the treatment of complex coronary lesions were enrolled in our hospital from March 2006 to September 2009. After percutaneous coronary intervention, the patients were randomised to receive control group (clopidogrel 75 mg /d and asprin 100 mg/d) (n = 67)or triple antiplatelet therapy group (cilostazol 100 mg twice a day for 3 months in addition to aspirin 100 mg/d and clopidogrel 75 mg/d) (n = 61), and then From 3 months to 12 months after the operation, all patients received 75 mg/d clopidogrel. The clinical characteristics, coronary lesion, paratmeter of double stents implantation and major cardiovascular event (MACE) of 128 patients in a follow-up period of a mean 20.4 ± 5.1 months were analysed. Results The ratios of fatal or non-fatal myocardial infarction (MI) and target vessel revascularisation (TVR) in a follow-up period were significantly lower in triple antiplatelet therapy group than in control group (6.56% vs11.94%, P = 0.043; 6.56% vs 13.43%, P = 0.042). So the overall incidence of primary end point including death, MI and TVR was obviously lower in triple antiplatelet therapy group than in control group (9.84% vs 17.91%, absolute risk reduction 8.07%, P = 0.043). There was no significant difference in the incidence of all-cause death between 2 groups (1.64% vs 2.99%, P = 0.615). The incidence of stent thrombosis during 30 days and follow-up period was obviously lower in triple antiplatelet therapy group than in control group (0% vs 2.99%, P = 0.050; 1.64% vs 4.48%, P = 0.048). While for secondary end points such as major and minor bleeding events, no significant difference was seen between 2 groups (1.64% vs 0%, P = 0.343; 3.28% vs 2.98%, P = 0.846). Conclusions A high clopidogrel maintenance dose of triple antiplatelet therapy for 3 months after PCI procedure reduces the risk of adverse events in patients undergoing multiple DESs for complex coronary lesions and appears to be safe.