Background— Whether triple antiplatelet therapy is superior or similar to dual antiplatelet therapy in patients with acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention in the era of drug-eluting stents remains unclear. Methods and Results— A total of 4203 ST-segment elevation myocardial infarction patients who underwent primary percutaneous coronary intervention with drug-eluting stents were analyzed retrospectively in the Korean Acute Myocardial Infarction Registry (KAMIR). They received either dual (aspirin plus clopidogrel; dual group; n=2569) or triple (aspirin plus clopidogrel plus cilostazol; triple group; n=1634) antiplatelet therapy. The triple group received additional cilostazol at least for 1 month. Various major adverse cardiac events at 8 months were compared between these 2 groups. Compared with the dual group, the triple group had a similar incidence of major bleeding events but a significantly lower incidence of in-hospital mortality. Clinical outcomes at 8 months showed that the triple group had significantly lower incidences of cardiac death (adjusted odds ratio, 0.52; 95% confidence interval, 0.32 to 0.84; P =0.007), total death (adjusted odds ratio, 0.60; 95% confidence interval, 0.41 to 0.89; P =0.010), and total major adverse cardiac events (adjusted odds ratio, 0.74; 95% confidence interval, 0.58 to 0.95; P =0.019) than the dual group. Subgroup analysis showed that older (>65 years old), female, and diabetic patients got more benefits from triple antiplatelet therapy than their counterparts who received dual antiplatelet therapy. Conclusions— Triple antiplatelet therapy seems to be superior to dual antiplatelet therapy in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention with drug-eluting stents. These results may provide the rationale for the use of triple antiplatelet therapy in these patients.

Choi BG, et al. Yonsei Med J. 2019 Feb;60(2):191-199. https://doi.org/10.3349/ymj.2019.60.2.191

The impact of sarcopenia on atherosclerotic cardiovascular disease remains unclear. We aimed to investigate the prognostic impact of sarcopenia on coronary artery disease (CAD). A total of 475 patients with CAD who underwent successful percutaneous coronary intervention (PCI) and computed tomography (CT) were enrolled. The cross-sectional area of skeletal muscle at the first lumbar (L1) vertebral level was measured, and sex-specific cut-off values of L1 skeletal muscle index (L1 SMI; male <31.00 cm²/m², female <25.00 cm²/m²) were obtained. The primary outcome was 3-year all-cause mortality and the secondary outcome was 3-year major adverse cardiovascular events (MACEs). Low L1 SMI was present in 141 (29.7%) of 475 patients. The incidence of all-cause mortality (23.7% vs. 5.9%, p < 0.001) and MACEs (39.6% vs. 11.8%, p < 0.001) was significantly higher in patients with low L1 SMI than in those with high L1 SMI. In multivariate analysis, low L1 SMI was an independent predictor of higher risk of all-cause mortality (hazard ratio (HR): 4.07; 95% confidence interval (CI): 1.95–8.45; p < 0.001) and MACEs (HR: 3.76; 95% CI: 2.27–6.23; p < 0.001). These findings remained consistent after propensity score-matched analysis with 91 patient pairs (C-statistic = 0.848). CT-diagnosed low skeletal muscle mass is a powerful predictor of adverse outcomes in patients with CAD undergoing PCI.

Background: Significant coronary artery disease has a well‐known association with long‐term adverse cardiovascular events. In this study, we aimed to evaluate its association with long‐term major adverse clinical events ( MACE ) up to 5 years in patients who presented with chest pain without significant coronary artery disease . Methods and Results: A total of 5890 subjects with chest pain without significant coronary artery disease were prospectively enrolled in this study. The mean follow‐up duration was 3.4 years. Multivariable Cox proportional hazards regression analysis was performed for assessing the independent risk factors for MACE or sustained angina pectoris. MACE was defined as the composite of total death, myocardial infarction, coronary revascularization, stroke, and hospitalization because of heart failure. Ninety‐one (2.2%) patients developed MACE , and 309 (8.1%) patients developed sustained angina pectoris , both within 5 years. In multivariable Cox proportional hazards regression analysis, the risk of MACE was significantly associated with age (per 5 years; hazard ratio [ HR ], 1.44; 95% CI , 1.30–1.60) and insignificant coronary stenosis (30%–70%; HR, 2.03; 95% CI; 1.28–3.21). The risk of sustained angina pectoris was significantly associated with age (per 5 years; HR, 1.05; 95% CI, 1.01–1.11), dyslipidemia ( HR, 1.34; 95% CI , 1.06–1.70), insignificant coronary stenosis ( HR, 2.54; 95% CI , 1.94–3.31), coronary artery spasm (HR, 1.42; 95% CI , 1.11–1.80), and myocardial bridge (HR, 1.37; 95% CI , 1.04–1.81). Conclusions: In patients without significant CAD , aging and insignificant coronary stenosis have a strong association with future long‐term MACE . Also, aging, dyslipidemia, insignificant coronary stenosis , coronary artery spasm, and myocardial bridge are strongly associated with future angina pectoris .

Serum uric acid (UA) has been known to have a positive association with blood pressure (BP). However, the relationship between serum UA and BP in different age groups is unclear. A total of 45,098 Koreans who underwent health examinations at Korea Association of Health Promotion with no history of taking drugs related with UA and/or BP were analyzed for determining the relationship between serum UA and BP. In men <40, serum UA was significantly associated with systolic (β = 0.25, p = 0.002) and diastolic BP (β = 0.41, p < 0.001) after adjustment for age, diabetes, dyslipidemia, body mass index, and estimated glomerular filtration rate. Men between ages 40 and 59 showed similar results regarding diastolic BP. The association between serum UA and BP was stronger in women <40 (β = 0.54, p < 0.001 for systolic BP; β = 0.65, p < 0.001 for diastolic BP) and in between 40 and 59 (β = 0.51, p < 0.001 for diastolic BP). The association was not significant in men and women ≥60. The odds ratios (ORs) of hyperuricemia for hypertension were 1.25 (95% confidence interval [CI], 1.08 to 1.45; p = 0.003) and 1.33 (95% CI, 1.11 to 1.60; p = 0.002) in men <40 and in between 40 and 59, respectively, in the multivariate analysis. The OR was 2.60 (95% CI, 1.37 to 4.94; p = 0.0034) in women <40. The relationship between hyperuricemia and hypertension was not significant in other age/gender groups. In contrast to the elderly of 60 and over, the non-elderly showed significant associations between serum UA and BP.