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

Abstract

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

Update on Cilostazol: A Critical Review of Its Antithrombotic and Cardiovascular Actions and Its Clinical Applications

“…Lesion length (≥28 mm; HR, 2.10), and platelet reactivity unit level at hospital discharge (every rise in tertile, HR, 1.61) were predictors of the primary end point; however, using cilostazol was not (HR, 0.90). In a subsequent analysis of this trial, it was reported that triple therapy significantly decreased in‐stent late loss ( P = .015) 177 . There was no interaction of stent type, lesion length, or diabetes with difference of late loss.…”

“…In a subsequent analysis of this trial, it was reported that triple therapy significantly decreased in-stent late loss (P = .015). 177 There was no interaction of stent type, lesion length, or diabetes with difference of late loss. However, cilostazolconferred decrease of late loss did not significantly reduce the rate of revascularization (7.8% vs 6.9%; P = .69).…”

Adjunctive Cilostazol to Dual Antiplatelet Therapy to Enhance Mobilization of Endothelial Progenitor Cell in Patients with Acute Myocardial Infarction: A Randomized, Placebo-Controlled EPISODE Trial

“…These clinical benefits of cilostazol have been attributed to its additional platelet inhibition on top of DAPT in PCI-treated patients. However, high on-clopidogrel platelet reactivity was more convincingly associated with the risk of stent thrombosis but less with in-stent restenosis [23,33,34]. EPC as a key effector of endothelial regeneration has been significantly associated with the risks of revascularization and thrombotic events after PCI [16].…”

Comparison of Shear Stress–Induced Thrombotic and Thrombolytic Effects Among 3 Different Antithrombotic Regimens in Patients With Acute Coronary Syndrome

“…Blood samples on day 2 were obtained after 12 to 24 hours from the study drug administration, according to previous studies. [17][18][19] Aspirin (100 mg/d) was maintained irrespective of other antithrombotic medications, and the use of ticagrelor (90 mg twice a day), CLP (75 mg/d) plus rivaroxaban (2.5 mg twice a day), or CLP (75mg/d) was maintained for 1 month. Otherwise, patients were treated as per international and local guidelines for ACS management.…”

“…Ischemic stroke was defined as a new focal neurologic deficit of vascular origin lasting at least 24 hours that was proven to be nonhemorrhagic by either computed tomography or magnetic resonance imaging scanning. 18 Safety assessments, including the occurrence of any bleeding complications, were evaluated during follow-up according to the Bleeding Academic Research Consortium criteria. 26…”