Key result
Triple antiplatelet therapy with cilostazol significantly reduced in-stent late loss at 6 months compared to dual antiplatelet therapy (0.54 mm vs 0.62 mm, p=0.015), but did not reduce target lesion revascularization.
Why the study?
Does triple antiplatelet therapy with cilostazol reduce in-stent late loss in patients receiving drug-eluting stents compared to dual antiplatelet therapy?
RCT (n=845)
Open-label
Randomized
Yes
Does triple antiplatelet therapy with cilostazol reduce in-stent late loss in patients receiving drug-eluting stents compared to dual antiplatelet therapy?
Adding cilostazol to dual antiplatelet therapy reduces angiographic in-stent late loss but does not significantly decrease the rate of target lesion revascularization in patients receiving drug-eluting stents.
May modestly reduce late loss without affecting TLR; leaves open clinical role of cilostazol triple therapy.
It 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.
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Suh et al. (2017) conducted an RCT in Coronary artery disease requiring drug-eluting stent implantation (n=845). Triple antiplatelet therapy (aspirin, clopidogrel, cilostazol) vs. Dual antiplatelet therapy (aspirin, clopidogrel) was evaluated on In-stent late loss at 6 months (MD 0.077, 95% CI 0.014-0.139, p=0.015). Triple antiplatelet therapy with cilostazol significantly reduced in-stent late loss at 6 months compared to dual antiplatelet therapy (0.54 mm vs 0.62 mm, p=0.015), but did not reduce target lesion revascularization.
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