Comparison of Triple Antiplatelet Therapy and Dual Antiplatelet Therapy in Patients at High Risk of Restenosis After Drug–Eluting Stent Implantation (from the DECLARE-DIABETES and -LONG Trials)

Lee, Seung Whan; Chun, Kook Jin; Park, Seong Wook; Kim, Hyun Sook; Kim, Young Hak; Yun, Sung Cheol; Kim, Won Jang; Lee, Jong‐Young; Park, Duk‐Woo; Lee, Cheol Whan; Hong, Myeong Ki; Rhee, Kyoung Suk; Chae, Jei Keon; Ko, Jung Ho; Park, Jae‐Hyeong; Lee, Jae‐Hwan; Choi, Si Wan; Jeong, Jin‐Ok; Seong, In Whan; Suh, Jon; Cho, Yoon Haeng; Lee, Nae Hee; Kim, June Hong; Park, Seung Jung

doi:10.1016/j.amjcard.2009.08.667

Cited by 51 publications

(28 citation statements)

References 19 publications

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“…9,23,24 This beneficial effect of cilostazol was more prominent in patients with long coronary lesions and in diabetic patients. 9, 21 Cilostazol use, however, was not associated with reduction of TLR at 6-month 10 or 2-year follow-up in the present study, and TAT failed to show a beneficial effect even when the patients were stratified according to diabetes or legion length (data not shown). These null results might have been due to several causes, such as the insufficient numbers of patients with low event rates, the existence of substantial numbers of resistant patients even against TAT, and the possible chronotropic side-effect of cilostazol, which has been already described.…”

Section: Study Limitationscontrasting

confidence: 44%

“…Several studies have reported the beneficial effects of TAT with cilostazol on cardiovascular outcome that persisted long after discontinuation of its use. 20, 21 Various activities of cilostazol, besides platelet inhibition, including improved endothelial function, suppression of inflammatory response and reduced neointimal formation, 3-6 provide the rationale for a possible legacy effect of TAT. In the present study, however, clinical events at 2 years after DES implantation were not different between the TAT and DAT groups.…”

Section: Study Limitationsmentioning

confidence: 99%

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Cilostazol Eliminates Adverse Smoking Outcome in Patients With Drug-Eluting Stent Implantation

Kim

Suh

Lee

et al. 2014

Circ J

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Background: The present study investigated whether cilostazol can eliminate adverse smoking outcome after percutaneous coronary intervention (PCI). Methods and Results:A total of 914 patients with successful drug-eluting stent (DES) implantation were randomly assigned to dual antiplatelet therapy (DAT; aspirin and clopidogrel, n=457) or to triple antiplatelet therapy (TAT; DAT with cilostazol, n=457). The effect of smoking on 2-year major adverse cardio/cerebrovascular events (MACCE) in both the TAT and DAT groups was evaluated. Total MACCE were not significantly different between the 2 anti-platelet regimens (9.8% in TAT vs. 11.4% in DAT groups, P=0.45), but the adverse effects of smoking on clinical outcome were different between DAT vs. TAT. Current smokers had a higher prevalence of MACCE than non-smokers in the DAT group (16.7% vs. 9.5%, P=0.04). In the TAT group, however, the adverse effect of smoking was abolished (9.2% vs. 10.1%, P=0.85). Regarding the effects of smoking on the antiplatelet effects of DAT or TAT, post-treatment platelet reactivity (in P2Y12 reaction units; PRU) in current smokers was not significantly lower than that in non-smokers in the DAT group, whereas, in the TAT group, it was significantly lower than that of non-smokers (189±88 vs. 216±89 PRU, P=0.01). Conclusions:Adverse clinical effects of smoking may be eliminated by the addition of cilostazol to DAT after DES implantation. This may be due to the stimulation of cilostazol's antiplatelet effects by smoking. (Circ J 2014; 78: 1420 -1427

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Section: Study Limitationscontrasting

confidence: 44%

Section: Study Limitationsmentioning

confidence: 99%

Cilostazol Eliminates Adverse Smoking Outcome in Patients With Drug-Eluting Stent Implantation

Kim

Suh

Lee

et al. 2014

Circ J

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“…The anti-proliferative effect of cilostazol in patients with high risk features: Previous studies suggested that cilostazol therapy could be beneficial in terms of resteno-CILOSTAZOL AND DRUG-ELUTING STENT RESTENOSIS sis, especially in patients with high-risk features, such as diabetes mellitus or long lesions. [5][6][7] However, the difference in in-stent late loss between the two groups did not interact with the type of DES (PES versus ZES), diabetic status, or lesion length in this study. This suggests that the anti-proliferative effect of cilostazol is not influenced by specific clinical or angiographic characteristics.…”

Section: )mentioning

confidence: 64%

“…[2][3][4] Previous studies showed the benefit of cilostazol in specific subgroups, such as diabetic patients and those with long coronary lesions. [5][6][7] However, it is not clear if these results can be extrapolated to the general population. The CILON-T trial was a prospective, randomized trial that compared the efficacy of dual antiplatelet therapy (DAT) (i.e., aspirin, clopidogrel) and triple antiplatelet therapy (TAT) (i.e., aspirin, clopidogrel, and cilostazol) in patients who underwent drug-eluting stent (DES) implan- tation.…”

mentioning

confidence: 99%

The Effect of Cilostazol on the Angiographic Outcome of Drug-Eluting Coronary Stents Angiographic Analysis of the CILON-T (Influence of CILostazol-Based Triple Antiplatelet Therapy ON Ischemi Complication after Drug-Eluting StenT Implantation) Trial

et al. 2017

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SummaryIt is not clear if anti-restonotic effect of cilostazol is consistent for different types of drug-eluting stents (DES).The purpose of this study was to compare the anti-proliferative effect of cilostazol between DAT and TAT with consideration of confounding influences of DES type.Nine hundred and fifteen patients were randomized to either dual antiplatelet therapy (DAT; aspirin and clopidogrel) or triple antiplatelet therapy (TAT; aspirin, clopidogrel, and cilostazol) in the previous CILON-T trial. After excluding 70 patients who received both or neither stents, we analyzed 845 patients who received exclusively PES or ZES, and compared in-stent late loss at 6 months between both antiplatelet regimens (DAT versus TAT).Baseline angiographic and clinical characteristics were similar between the DAT (656 lesions in 425 patients) and the TAT group (600 lesions in 420 patients). The 6-month follow-up angiography was completed in 745 patients (88.2%). Quantitative coronary angiography showed that TAT significantly reduced in-stent late loss (DAT 0.62 ± 0.62 mm versus TAT 0.54 ± 0.49 mm, P = 0.015). Stent type, diabetes or lesion length did not interact with difference of late loss. However, reduction of late loss by cilostazol did not lead to a significant reduction in the rate of target lesion revascularization (TLR) (DAT 7.8% versus TAT 6.9%, P = 0.69) due to a nonlinear relationship found between late loss and TLR.The TAT group showed less in-stent late loss as compared to the DAT group. This was consistently observed regardless of DES type, lesion length, or diabetic status. However, reduction of late loss by cilostazol did not lead to a significant reduction in TLR.(Int Heart J 2017; 58: 853-860) Key words: Cilostazol, Paclitaxel-eluting stent, Zotarolimus-eluting stent, Restenosis C ilostazol is a selective phosphodiesterase (PDE) 3 inhibitor that is commonly prescribed in patients with peripheral artery disease. It reduces restenosis of bare metal stents and drugeluting stents (DES) after percutaneous coronary intervention (PCI) as a result of its anti-proliferative effect.1) It also intensified platelet inhibition in patients who showed high post-treatment platelet reactivity despite conventional dual antiplatelet therapy (DAPT). 2-4)Previous studies showed the benefit of cilostazol in specific subgroups, such as diabetic patients and those with long coronary lesions.5-7) However, it is not clear if these results can be extrapolated to the general population. The CILON-T trial was a prospective, randomized trial that compared the efficacy of dual antiplatelet therapy (DAT) (i.e., aspirin, clopidogrel) and triple antiplatelet therapy (TAT) (i.e., aspirin, clopidogrel, and cilostazol) in patients who underwent drug-eluting stent (DES) implanFrom the

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“…Cilostazol was also administrated in high risk patients implanted with drug-eluting stents [5]. Some Korean colleagues used cilostazol in patients having acute myocardial infarction (AMI) and still an exciting result was achieved [6].…”

Section: Discussionmentioning

confidence: 99%

Premature Ventricular Contractions (PVCs) Induced by Administration of Cilostazol after Myocardial Infarction

Zhong¹,

Gao²,

Li³

et al. 2013

RusOMJ

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Cilostazol is a phosphodiesterase III inhibitor, which was approved by FDA (food and drug administration) for intermittent claudication in 1999. What made it known to cardiologists is the Cilostazol for Restenosis Trial (CREST), in which cilostazol was shown to significantly lower binary restenosis rate. Here we reported one case of acquired premature ventricular contractions (PVCs) during taking cilostazol. A 68-year-old male patient was diagnosed acute myocardial infarction and given percutaneous coronary intervention (PCI). It turned out there was thrombi in the distal right coronary artery. The patient was discharged taking cilostazol (100mg Bid) together with aspirin and clopidogrel. On follow-up, there were PVCs coming up (more than 27000 beats in 24-hour electrocardiography) and cilostazol was discontinued afterwards. After taking metoprolol (25 mg, Tid) for one week, the PVCs were decreased significantly, 600 beats/24 hours. In our case, the PVCs are obviously related to cilostazol and probably the safety of cilostazol in patients having a history of myocardial infarction or malignant arrhythmias should be reevaluated.

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Comparison of Triple Antiplatelet Therapy and Dual Antiplatelet Therapy in Patients at High Risk of Restenosis After Drug–Eluting Stent Implantation (from the DECLARE-DIABETES and -LONG Trials)

Cited by 51 publications

References 19 publications

Cilostazol Eliminates Adverse Smoking Outcome in Patients With Drug-Eluting Stent Implantation

Cilostazol Eliminates Adverse Smoking Outcome in Patients With Drug-Eluting Stent Implantation

The Effect of Cilostazol on the Angiographic Outcome of Drug-Eluting Coronary Stents Angiographic Analysis of the CILON-T (Influence of CILostazol-Based Triple Antiplatelet Therapy ON Ischemi Complication after Drug-Eluting StenT Implantation) Trial

Premature Ventricular Contractions (PVCs) Induced by Administration of Cilostazol after Myocardial Infarction

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