Current guidelines for the management of acute
myocardial infarction (AMI) recommend potent P2Y12 inhibitors rather than
clopidogrel to prevent ischemic events. However, their ischemic benefits are offset by an increased major
bleeding risk. We compared the efficacy and safety of triple antiplatelet
therapy with
cilostazol in the first month after AMI. This study investigated 16,643 AMI patients who received
percutaneous coronary intervention (PCI) with
drug-eluting stents (DES) in nationwide, real-world, multicenter registries in Korea. Patients were divided into
DAPT (
aspirin and
clopidogrel, n = 11,285), Triple (
aspirin,
clopidogrel and
cilostazol, n = 2547), and Potent (
aspirin and
ticagrelor/
prasugrel, n = 2811) groups. The primary outcomes were net adverse clinical events (NACE), a composite of death from any cause,
myocardial infarction (MI),
stroke, and TIMI major
bleeding one month after AMI. After adjusting for covariates, there were no statistically significant differences in the risk of death from any cause, MI, or
stroke between the three groups. However, the risk of TIMI major
bleeding was significantly greater in the Potent group than in the
DAPT and Triple groups (p < 0.001). Accordingly, NACE was significantly higher in the
DAPT (HR 1.265; 95% CI 1.006−1.591, p = 0.044) and Potent groups (HR 1.515; 95% CI 1.142−2.011, p = 0.004) than in the Triple group. Triple antiplatelet
therapy with
cilostazol was associated with an improved net clinical outcome in the first month after AMI without increasing the risk of
bleeding compared to potent or standard P2Y12 inhibitor-based
DAPT.