Elsevier

American Heart Journal

Volume 167, Issue 2, February 2014, Pages 241-248.e1
American Heart Journal

Clinical Investigation
Interventional Cardiology
Multicenter randomized trial of 3-month cilostazol use in addition to dual antiplatelet therapy after biolimus-eluting stent implantation for long or multivessel coronary artery disease

https://doi.org/10.1016/j.ahj.2013.08.028Get rights and content

Background

There are conflicting data on the use of cilostazol as triple antiplatelet therapy (TAPT) for improving clinical outcomes after drug-eluting stent implantation. We aimed to evaluate whether 3-month use of cilostazol in addition to dual antiplatelet therapy (DAPT) improved clinical outcomes in patients with long or multivessel coronary artery disease (CAD) after biolimus-eluting stent (BES) implantation.

Methods

Patients (n = 630) who had been successfully treated with BES implantation for lesions with ≥28 mm in stent length or ≥2 stents for different coronary arteries were enrolled in this prospective randomized multicenter trial. All patients were randomly assigned to receive either DAPT (aspirin and clopidogrel for 12 months, n = 314) or TAPT (DAPT plus 3-month cilostazol use, n = 316). The primary end point was a device-oriented composite consisting of cardiac death, myocardial infarction (not clearly attributable to a nontarget vessel), and ischemia-driven target lesion revascularization at 1-year follow-up.

Results

A total of 314 patients in DAPT and 308 patients in TAPT were analyzed. Multivessel CAD was present in 65.7% of patients. Stents ≥28 mm in length were implanted in 58.1% of lesions. There were no significant differences in baseline and angiographic characteristics between the 2 groups. The primary end point was similar between the 2 groups (2.3% in DAPT vs 1.9% in TAPT, log-rank P = .799).

Conclusions

In patients treated with BES implantation for long or multivessel CAD, 3 months of cilostazol use in addition to DAPT did not improve clinical outcome at 1-year follow-up.

Section snippets

Background

The use of drug-eluting stents (DES) has reduced the rate of repeat revascularization without increasing the risk of death or myocardial infarction (MI) in patients with coronary artery disease (CAD) compared with patients treated with bare-metal stents.1 However, DES use is still associated with a high rate of adverse clinical outcomes in patients with diffuse long or multivessel CAD.2

Cilostazol is a selective phosphodiesterase-3 inhibitor with antiplatelet and antiproliferative effects.

Study population

The ABCD trial was a prospective, open-label, randomized trial at 18 institutions in South Korea. Patients were enrolled between March 2010 and July 2011. Patients with diffuse long or multivessel CAD who had been successfully treated with BES implantation were eligible for this study. Diffuse long lesion was defined when the total implanted stent length in 1 coronary artery was ≥28 mm, and multivessel CAD was defined when ≥2 stents, regardless of stent length, were implanted in different

Results

The study flowchart is shown in Figure 1. Among patients who were randomized, 7 patients from the DAPT group and 8 from the TAPT group were excluded from analysis because of withdrawal from the trial and study protocol violation. The total dropout rate was approximately 2.4%, which was within the expected range.

Discussion

This prospective randomized controlled trial showed that 3-month use of cilostazol as TAPT did not improve clinical outcomes in patients with diffuse long or multivessel CAD treated with BES implantation compared with patients treated with DAPT. This trial also revealed that 12% of patients in the TAPT group could not continue cilostazol for 3 months.

To date, the role of cilostazol in patients treated with new generation DES, especially BES, has not been evaluated. Three recent trials,

Conclusion

In patients treated with BES implantation for long or multivessel CAD, 3-month use of cilostazol in addition to DAPT did not improve clinical outcomes at 1-year follow-up.

Disclosures

Conflicts of interest: The authors of this manuscript have no relevant financial relationships to disclose or conflicts of interest to resolve.

References (16)

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On behalf of ABCD investigators. See online Appendix for a complete listing.

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