Benefit of triple antiplatelet treatment in elderly patients with ST Elevation Myocardial Infarction (STEMI) undergone Primary percutaneous coronary intervention (PCI) : Data from INTERSTELLAR cohort

초록

Objectives Triple antiplatelet therapy (TAT) including cilostazolhas showed beneficial effect on mortality withsafety in patients with ST elevation myocardial infarction (STEMI) compared to dual antiplatelet therapy (DAT). However, considering the bleeding risk in elderly patients, it is not clear whether these beneficial effects also show or not. Thus, we compared the effect of triple antiplatelet therapy (TAT) with DAT in elderly patients with STEMI underwent primary PCI. Methods From 2007 to 2014, a total of 1401 consecutive patients (79.6% male) with STEMI underwent primary PCI were analyzed retrospectively. Patients were divided into two groups according to their age (group 1: < 75 years old, group 2: ≥75 years old). Primary endpoint was all-cause mortality during follow-up period. Results Of the 1401 patients, there were 1160 (82.8%, mean age 56.3±10.4) patients in group 1, 241 (17.2%, 80.3±4.5) patients in group 2.Prevalence of DM, hypertension and multi-vessel disease were more common in group 2.In group 1, there were 235 patients (20.3%) with TAT and 29 patients (12.0%) with TAT in group 2. Over a mean follow-up period of 2.1±1.5 years, there were 90 in deaths (4.3% in group 1 vs. 28.3%in group 2). Kaplan-Meier survival analysis revealed that TATwas associated with lower mortality rate in group 1 (log rank p-value=0.023). Whereas, this beneficial effect was not noted in group 2 (log rank p-value=0.958). Conclusions On the contrary to young patients (< 75 years old), TAT was not associated survival benefit compared to DAT in elderly patients (≥75 years old) with STEMI underwent primary PCI.