Clinical Effects of Additional Cilostazol Administration After Drug-Eluting Stent Insertion.
- Author:
Dong Sung KUM
1
;
Moo Hyun KIM
;
Jeung Hoan PAIK
;
Long Hao YU
;
Jin HAN
;
Kyung Ho KIM
;
Tae Ho PARK
;
Kwang Soo CHA
;
Young Dae KIM
;
Mei Lian QUAN
;
Jin Yeong HAN
Author Information
- Publication Type:Original Article ; Randomized Controlled Trial
- Keywords: Drug-eluting stents; Platelet aggregation; Cilostazol
- MeSH: Adenosine Diphosphate; Adenosine Monophosphate; Arachidonic Acid; Aspirin; Blood Platelets; Collagen; Cyclic Nucleotide Phosphodiesterases, Type 3; Drug-Eluting Stents; Epinephrine; Humans; Incidence; Myocardial Infarction; Percutaneous Coronary Intervention; Platelet Aggregation; Prospective Studies; Ristocetin; Second Messenger Systems; Stents; Tetrazoles; Thrombosis; Ticlopidine; Vasodilation
- From:Korean Circulation Journal 2009;39(1):21-25
- CountryRepublic of Korea
- Language:Korean
- Abstract: BACKGROUND AND OBJECTIVES: Cilostazol, a selective inhibitor of phosphodiesterase III (PDE III), prevents inactivation of the intracellular second messenger cyclic adenosine monophosphate (cAMP) and irreversibly inhibits platelet aggregation and vasodilation. Hence, we performed this prospective randomized study to evaluate the clinical effects of additional cilostazol administration in patients receiving dual antiplatelet therapy after drug-eluting stent (DES) insertion. SUBJECTS AND METHODS: Between December 2003 and June 2006, we enrolled a total 603 consecutive patients who underwent successful percutaneous coronary intervention (PCI) with DES insertion at Dong-A University Hospital. Study patients received dual antiplatelet therapy (aspirin and clopidogrel, n=301) for at least six months or dual antiplatelet therapy (six months) combined with cilostazol medication for one month (triple therapy, n=302) after PCI. We investigated the incidence of major adverse cardiac events (MACE) at one month and six months after the initiation of medical therapy. MACE was defined as a composite of death, myocardial infarction (MI), stent thrombosis, and target lesion revascularization (TLR). Platelet function was evaluated in 66 patients (dual therapy group, n=40; triple therapy group, n=26) using a Chrono-Log platelet aggregometer and the VerifyNow P2Y12 assay system. RESULTS: The MACE rate was 0.66% in the triple therapy group (death only, 0.67%) and 1.67% in the dual therapy group (death, 0.67%; MI, 0.67%; stent thrombosis, 0.99%; TLR, 0.99%) at one month after PCI (p=0.087). At six months, there were no differences in the MACE rate between the two groups (triple group vs. dual group=2.65% vs. 3.99%, p=0.864). In laboratory tests, platelet aggregation induced by agonists of ADP (27.92+/-13.04% vs. 40.9+/-15.78%, p=0.0008), collagen (13.73+/-6.95% vs. 27.43+/-14.87%, p=0.03), and epinephrine (10.38+/-7.82% vs. 15.5+/-10.45%, p=0.0000) were lower in the triple therapy group versus the dual therapy group. However, platelet aggregation induced by agonists of arachidonic acid (3.23+/-1.07% vs. 3.78+/-2.12%, p=0.23) and ristocetin (29.19+/-35.55% vs. 44.78+/-32.65%, p=0.07) and aspirin reaction unit (412.96+/-96.25 vs. 427.93+/-76.24, p=0.48) measured by VerifyNow were not different in the triple group versus the dual group. CONCLUSION: Additional administration of cilostazol did not decrease the MACE rate when compared to dual therapy six months after PCI in patients with DES.
