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Effective platelet inhibition is of paramount importance in patient undergoing high risk PCI like LV dysfunction for prevention of early and late stent related complications. We want to study the effect of triple antiplatelet (TAP) regimen (Aspirin, Clopidogrel and Cilostazol) on platelet aggregation (PA) and long term outcome in this subset of patients.
We retrospectively analyzed the details of patients with severe LV dysfunction who underwent PCI in Jan 2010 to Dec 2010 in our unit, who were on TAP regimen during first month post PCI (after one month they were kept on DAP agents for one year and thereafter on Aspirin only). We recorded their PA on 15th day post PCI and their MACE (all cause death, MI, TLR, TVR, worsening of symptoms of angina or HF, hospitalization due to HF) at 2 yrs and non-cardiac events (NCE) (CVA, puncture site complications and renal dysfunction).
Out of 215 eligible pts 177 (82.3%) were males (average age-54.98±11.351 yrs). 139 (64.7%) were hypertensive, 96 (44.7%) were diabetic and 64 (29.8%) were smokers. A total of 304 lesions were treated by PCI of which 55 (25.6%) were multivessel. Transrdial PCI in 104 (48.4%) pts and DES in 149 (49.01%) lesions. 133 lesions in LAD, 68 in LCX-OM, 91 in RCA-PDA, 2 in LIMA to LAD, 6 in SVG grafts and 4 ISR. Average stent size was 2.89±0.3mm and stent length was 19.4±5.7mm. On day 15, average PA was 40.31±23.04%. Five patients were lost to follow up and remaining 210 patients were followed up for 2 yrs. 166 (77.2%) patients remained asymptomatic and 44 (22.8%) patients had one or more MACE or non cardiac events. 40 patients had MACE, 8 patients had NCE which included 4 patients who also had MACE. 8 patients underwent TVR (1 stent thrombosis, 7 ISR) and 12 patients underwent non TVR (8 PCI, 4 CABG). Out of 11 patients were hospitalized for heart failure, 9 had patent stent. 3 patients died, 2 with LVF and 1 after CABG.
Effective platelet inhibition with TAP regimen in high risk patients with LV dysfunction and CAD resulted in clinical benefit in the form of low MACE and NCE during long term follow up despite only nearly 50% of DES usage.