Author + information
- Received August 6, 2007
- Revision received November 12, 2007
- Accepted November 13, 2007
- Published online March 25, 2008.
- Seung-Whan Lee, MD, PhD⁎,
- Seong-Wook Park, MD, PhD, FACC⁎,⁎ (, )
- Young-Hak Kim, MD, PhD⁎,
- Sung-Cheol Yun, PhD⁎,
- Duk-Woo Park, MD, PhD⁎,
- Cheol Whan Lee, MD, PhD⁎,
- Myeong-Ki Hong, MD, PhD⁎,
- Hyun-Sook Kim, MD, PhD†,
- Jae-Ki Ko, MD, PhD†,
- Jae-Hyeong Park, MD, PhD‡,
- Jae-Hwan Lee, MD‡,
- Si Wan Choi, MD‡,
- In-Whan Seong, MD, PhD‡,
- Yoon Haeng Cho, MD, PhD§,
- Nae-Hee Lee, MD, PhD§,
- June Hong Kim, MD, PhD∥,
- Kook-Jin Chun, MD∥ and
- Seung-Jung Park, MD, PhD, FACC⁎
- ↵⁎Reprint requests and correspondence:
Dr. Seong-Wook Park, Department of Medicine, University of Ulsan College of Medicine, Asan Medical Center, 388–1 Poongnap–dong, Songpa-gu, Seoul, 138-736, Korea.
Objectives We sought to evaluate the impact of cilostazol on neointimal hyperplasia after drug-eluting stent (DES) implantation in patients with diabetes mellitus (DM).
Background Although cilostazol has reduced the extent of neointimal hyperplasia and restenosis in patients after bare-metal stent implantation, it is not known whether this effect occurs after DES implantation in diabetic patients.
Methods This randomized, multicenter, prospective study compared triple antiplatelet therapy (aspirin, clopidogrel, and cilostazol, triple group, n = 200) and dual antiplatelet therapy (aspirin and clopidogrel, standard group, n = 200) for 6 months in patients with DM receiving DES. The primary end point was in-stent late loss at 6 months.
Results The 2 groups had similar baseline clinical and angiographic characteristics. The in-stent (0.25 ± 0.53 mm vs. 0.38 ± 0.54 mm, p = 0.025) and in-segment (0.42 ± 0.50 mm vs. 0.53 ± 0.49 mm, p = 0.031) late loss were significantly lower in the triple versus standard group, as were 6-month in-segment restenosis (8.0% vs. 15.6%, p = 0.033) and 9-month target lesion revascularization (TLR) (2.5% vs. 7.0%, p = 0.034). At 9 months, major adverse cardiac events, including death, myocardial infarction, and TLR, tended to be lower in the triple than in the standard group (3.0% vs. 7.0%, p = 0.066). Multivariate analysis showed that sirolimus-eluting stents and the use of cilostazol were strong predictors of reduced restenosis or TLR.
Conclusions Triple antiplatelet therapy after DES implantation decreased angiographic restenosis and extent of late loss, resulting in a reduced risk of 9-month TLR compared with dual antiplatelet therapy in diabetic patients.
This study was supported by the Cardiovascular Research Foundation (Korea), a grant from the Korean Ministry of Health & Welfare as part of the Korea Health 21 Research & Development Project (0412-CR02-0704-0001).
- Received August 6, 2007.
- Revision received November 12, 2007.
- Accepted November 13, 2007.
- American College of Cardiology Foundation