Reduction Of Complication In ACS Patients After PCI Within30Days By Triple Anti-platelet Therapy

Objective:A retrospective study to investigate the safety and efficacy of triple anti-platelet therapy(low-dose tirofiban plus aspirin and clopidogrel)comparing to dual anti-platelet therapy (aspirin and clopidogrel) by analyzing the incidence of stent thrombosis (ST) and major adverse cardiac events (MACE) within30days after implantation of drug-eluting stent (DES) in patients with acute coronary syndrome (ACS).Then selecting the old acute coronary syndrome patients who is more than or equal to60yesrs old and dividing to the triple anti-platelet group and dual anti-platelet therapy group, we investigated the safety and efficacy of triple anti-platelet therapy comparing to dual anti-platelet therapy by analyzing the incidence of ST and MACE within30days after implantation of DES.Method:we enrolled2904ACS patients who underwent coronary stenting with DES from March2004to November2010.Some patients were treated with dual anti-platelet therapy (DAT, n=1145) while others with triple anti-platelet therapy (TAT, n1759). We compared the incidence of ST,MACE and side effects between the two groups within30days after PCI. Then, selecting1629senile patients(more than or equal to60years old) and dividing to the triple anti-platelet group(n=1040)and dual anti-platelet therapy group(n=589), we investigated the safety and efficacy of triple anti-platelet therapy comparing to dual anti-platelet therapy by analyzing the incidence of ST and MACE within30days after implantation of DES.Result:a. the ACS patients:(1) Although there are significant differences between the two groups in age,the degree of coronary stenosis, the ratio of smoking, diabetes, hyperlipidemia and coronary diffuse lesion, they have no influence to the end points by cox anlalysis. The rest of the baseline between the two groups is similar.(2)The incidence of primary end point (ST) is lower in TAT group than DAT group (0.11%vs.1.05%, HR:0.108,95%CI:0.024-0.483,P=0.0036), reducing the relative risk by89.52%.In addition,the incidence of secondary end point (MACE) is also lower in TAT group than DAT group(0.17%vs.1.48%, HR:0.114,95%CI:0.034-0.390, P0.0005) which reduced the relative risk by88.51%.Among the total,the incidence of cardiac death and urgent target vessel revascularization in TAT group is lower than DAT group and the difference is significant. However, there is no difference between the two groups in the incidence of myocardial infarction.(3)Both of the two groups have no severe hemorrhage,the incidence of mild hemorrhage is similar in the two groups(0.45%vs.0.35%, p=0.6720).Besides,the incidence of thrombocytopenia between the two groups is also similar.(0.45%vs.0.09%, p=0.083). b. the senile ACS patients:(1) Although there are significant differences between the two groups in age, hyperlipidemia, the ratio of acute myocardial infarction and right coronary artery lesion, left ventricular ejection fraction, they have no influence to the end points by cox anlalysis. The rest of the baseline between the two groups is similar.(2)The incidence of primary end point (ST) is lower in senile TAT group than senile DAT group(0.096%vs.1.19%, HR:13.422,95%CI:1.654-109.240,P=0.015), reducing the relative risk by91.93%.In addition,the incidence of secondary end point (MACE) is also lower in senile TAT group than senile DAT group(0.192%vs.1.528%, HR:8.015,95%CI:1.732-37.094,P=0.0078) which reduced the relative risk by87.43%.Among the total,the incidence of urgent target vessel revascularization in senile TAT group is lower than senile DAT group and the difference is significant. However, there is no difference between the two groups in the incidence of myocardial infarction and cardiac death.(3)Both of the two groups have no severe hemorrhage,the incidence of mild hemorrhage is similar in the two groups(0.29%vs.0.17%, p=1.00).Besides,the incidence of thrombocytopenia between the two groups is also similar.(0.29%vs.0.00%, p-0.482).Conclusion:The patients with ACS in the TAT group have significant lower incidence of ST and MACE than the DAT group within30days after PCI. While the risk of bleeding and the incidence of thrombocytopenia are not increased. Similar, The senile patients with ACS in the TAT group have significant lower incidence of ST and MACE than the senile DAT group within30days after PCI. While the risk of bleeding and the incidence of thrombocytopenia are not increased.