pISSN 1738-5520 eISSN 1738-5555
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Open Access, Peer-reviewed, Monthly
    Korean Circ J. 2009 Jan;39(1):21-25. Korean.
    Published online Jan 31, 2009.
    https://doi.org/10.4070/kcj.2009.39.1.21
    Copyright © 2009 The Korean Society of Cardiology
    Original Article

    Clinical Effects of Additional Cilostazol Administration After Drug-Eluting Stent Insertion

    Dong Sung Kum, MD,1 Moo Hyun Kim, MD,1 Jeung Hoan Paik, MD,1 Long Hao Yu, MD,1 Jin Han, MD,1 Kyung Ho Kim, MD,1 Tae Ho Park, MD,1 Kwang Soo Cha, MD,1 Young Dae Kim, MD,1 Mei Lian Quan, MD,2 and Jin Yeong Han, MD2
      • 1Department of Internal Medicine, College of Medicine, Dong-A University, Busan, Korea.
      • 2Department of Laboratory Medicine, College of Medicine, Dong-A University, Busan, Korea.
    • Correspondence: Moo Hyun Kim, MD, Department of Internal Medicine, College of Medicine, Dong-A University, 1 Dongdaesin-dong 3-ga, Seo-gu, Busan 602-715, Korea. Tel: 82-51-240-2976, Fax: 82-51-243-0116, Email: kimmh@dau.ac.kr
    Received June 02, 2008; Revised September 16, 2008; Accepted September 25, 2008.

    Abstract

    Background and Objectives

    Cilostazol, a selective inhibitor of phosphodiesterase III (PDE III), prevents inactivation of the intracellular second messenger cyclic adenosine monophosphate (cAMP) and irreversibly inhibits platelet aggregation and vasodilation. Hence, we performed this prospective randomized study to evaluate the clinical effects of additional cilostazol administration in patients receiving dual antiplatelet therapy after drug-eluting stent (DES) insertion.

    Subjects and Methods

    Between December 2003 and June 2006, we enrolled a total 603 consecutive patients who underwent successful percutaneous coronary intervention (PCI) with DES insertion at Dong-A University Hospital. Study patients received dual antiplatelet therapy (aspirin and clopidogrel, n=301) for at least six months or dual antiplatelet therapy (six months) combined with cilostazol medication for one month (triple therapy, n=302) after PCI. We investigated the incidence of major adverse cardiac events (MACE) at one month and six months after the initiation of medical therapy. MACE was defined as a composite of death, myocardial infarction (MI), stent thrombosis, and target lesion revascularization (TLR). Platelet function was evaluated in 66 patients (dual therapy group, n=40; triple therapy group, n=26) using a Chrono-Log platelet aggregometer and the VerifyNow P2Y12 assay system.

    Results

    The MACE rate was 0.66% in the triple therapy group (death only, 0.67%) and 1.67% in the dual therapy group (death, 0.67%; MI, 0.67%; stent thrombosis, 0.99%; TLR, 0.99%) at one month after PCI (p=0.087). At six months, there were no differences in the MACE rate between the two groups (triple group vs. dual group=2.65% vs. 3.99%, p=0.864). In laboratory tests, platelet aggregation induced by agonists of ADP (27.92±13.04% vs. 40.9±15.78%, p=0.0008), collagen (13.73±6.95% vs. 27.43±14.87%, p=0.03), and epinephrine (10.38±7.82% vs. 15.5±10.45%, p=0.0000) were lower in the triple therapy group versus the dual therapy group. However, platelet aggregation induced by agonists of arachidonic acid (3.23±1.07% vs. 3.78±2.12%, p=0.23) and ristocetin (29.19±35.55% vs. 44.78±32.65%, p=0.07) and aspirin reaction unit (412.96±96.25 vs. 427.93±76.24, p=0.48) measured by VerifyNow were not different in the triple group versus the dual group.

    Conclusion

    Additional administration of cilostazol did not decrease the MACE rate when compared to dual therapy six months after PCI in patients with DES.

    Keywords
    Drug-eluting stents; Platelet aggregation; Cilostazol

    Tables

    Table 1
    Clinical and procedural characteristics of the study patients

    Table 2
    Clinical outcome of the study patients

    Table 3
    Laboratory findings related to platelet function

    Acknowledgments

    This study was supported by research funds from Dong-A university.

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    MeSH Terms
    Adenosine Diphosphate
    Adenosine Monophosphate
    Arachidonic Acid
    Aspirin
    Blood Platelets
    Collagen
    Cyclic Nucleotide Phosphodiesterases, Type 3
    Drug-Eluting Stents
    Epinephrine
    Humans
    Incidence
    Myocardial Infarction
    Percutaneous Coronary Intervention
    Platelet Aggregation
    Prospective Studies
    Ristocetin
    Second Messenger Systems
    Stents
    Tetrazoles
    Thrombosis
    Ticlopidine
    Vasodilation
    Metrics
    Share
    Tables
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