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