Author + information
- Hiroshi Ueda,
- Kojiro Yoshimura,
- Atsumichi Kido,
- Kenji Natsuyama,
- Seiji Matsuhisa,
- Koichiro Asawa,
- Naohiro Yoshida,
- Kazushige Yamaguchi,
- Yasushi Sasaki,
- Yukiko Kuga,
- Masahiro Yamasaki,
- Kazuya Ueda and
- Yasunori Nishida
Although polyvascular disease is a predictor of future ischemic events, long-term antiplatelet therapy after coronary stenting is not well established in terms of the secondary prevention of systemic vascular diseases. We performed a clinical randomized trial to evaluate the effect of cilostazol in patients undergoing coronary stent placement with and without prior cerebral infarction.
A total of 307 patients who had undergone coronary stent implantation more than 6 months previously were randomly assigned to receive cilostazol plus aspirin therapy (cilostazol group, n=152) or aspirin monotherapy (aspirin group, n=155) after completion of dual antiplatelet therapy with aspirin and a thienopyridine. The primary efficacy endpoint was a composite of death, myocardial infarction, cerebral infarction, or coronary or cerebrovascular revascularization at 2 years after randomization. The primary safety endpoint was major or minor bleeding.
The patients had a mean age of 68 years, and 72% were men. At 2 years, follow-up clinical data were available for 98% of patients. The primary efficacy endpoint occurred in 11.6% of patients in the cilostazol group and 20.1% of patients in the aspirin group (hazard ratio [HR], 0.55; 95% confidence interval [CI], 0.30 to 0.99; P=0.047). Among patients with prior cerebral infarction, the event rate was significantly lower in the cilostazol group than in the aspirin group (17.2% versus 35.1%; HR, 0.41; 95% CI, 0.19 to 0.88; P=0.022), whereas among patients without prior cerebral infarction, there was no significant difference between the groups (8.0% and 11.3%, respectively; HR, 0.72; 95% CI, 0.28 to 1.86; P=0.50). The primary safety endpoint was similar between the cilostazol group and the aspirin group (2.7% and 4.5%, respectively; HR, 0.59; 95% CI, 0.17 to 2.02; P=0.40).
Among patients with coronary stent implantation, the addition of cilostazol to aspirin reduced the incidence of cardiac and cerebrovascular events at 2 years. The impact of cilostazol was more prominent in patients with prior cerebral infarction than without prior cerebral infarction.
West, Room 3014
Saturday, March 09, 2013, 9:00 a.m.-9:15 a.m.
Session Title: The Cutting Edge in Revascularization for SIHD
Abstract Category: 11. Chronic CAD/Stable Ischemic Heart Disease: Therapy
Presentation Number: 910-7
- 2013 American College of Cardiology Foundation