Comparison of triple anti-platelet therapy and dual anti-platelet therapy in patients with acute myocardial infarction who had no-reflow phenomenon during percutaneous coronary intervention

Circ J. 2013;77(12):2973-81. doi: 10.1253/circj.cj-13-0594. Epub 2013 Aug 29.


Background: No-reflow phenomenon is a serious complication of percutaneous coronary intervention (PCI) and associated with poor prognosis. The aim of this study was to determine whether triple anti-platelet therapy could improve clinical outcome in patients with acute myocardial infarction (AMI) who had no-reflow phenomenon during PCI compared with dual anti-platelet therapy.

Methods and results: A total of 727 eligible patients received either dual anti-platelet therapy (aspirin and clopidogrel; dual group, n=532) or triple anti-platelet therapy (aspirin, clopidogrel, and cilostazol; triple group, n=195). The triple group received additional cilostazol for at least 1 month. One-year major adverse cardiac events (MACE) including death, myocardial infarction (MI), target vessel revascularization (TVR) and coronary artery bypass graft (CABG) were evaluated. The triple group had a similar incidence of major bleeding and in-hospital mortality compared with the dual group. At 1 year, the triple group had significantly lower cardiac mortality (17.7% vs. 11.8%, log-rank P=0.039), lower all-cause mortality (19.0% vs. 12.3%, log-rank P=0.035), and lower incidence of composite MACE (25.9% vs. 16.9%, adjusted hazard ratio, 0.50; 95% confidence interval: 0.31-0.80, P=0.004) compared with the dual group with no differences in MI and TVR.

Conclusions: Triple anti-platelet therapy seems to be superior to dual anti-platelet therapy in patients with AMI who had no-reflow phenomenon during PCI.

Publication types

  • Clinical Trial
  • Comparative Study
  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Disease-Free Survival
  • Drug Therapy, Combination
  • Female
  • Follow-Up Studies
  • Hospital Mortality
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • No-Reflow Phenomenon / mortality*
  • No-Reflow Phenomenon / therapy*
  • Percutaneous Coronary Intervention*
  • Platelet Aggregation Inhibitors / administration & dosage*
  • Survival Rate


  • Platelet Aggregation Inhibitors