Author + information
- Seung-Whan Lee,
- Seung Mo Kang,
- Young-Rak Cho,
- Gyung-Min Park,
- Jung-Min Ahn,
- Jong-Young Lee,
- Won-Jang Kim,
- Soo-Jin Kang,
- Duk-Woo Park,
- Young-Hak Kim,
- Cheol Whan Lee,
- Seong-Wook Park and
- Seung-Jung Park
To assess impact of cilostazol on angiographic restenosis after drug-eluting stent (DES) implantation in patients with diabetes mellitus (DM) or long lesions. Restenosis after DES remains a significant clinical problem in complex coronary lesions.
Pooled analysis of three randomized studies in patients with DM (DECLARE-DIABETES) and long lesion (DECLARE-LONG I and II) compared triple antiplatelet therapy (aspirin, clopidogrel and cilostazol, triple group, n=700) and dual antiplatelet therapy (aspirin and clopidogrel, standard group, n=699) receiving sirolimus- (SES), paclitaxel- (PES), and zotarolimus-eluting stent (ZES). We analyzed follow-up angiographic outcomes.
Triple group significantly reduced in-stent restenosis (8.2% vs. 13.6%; RR 0.60; 95% CI, 0.53-0.84, p<0.001) and in-segment (9.0% vs. 15.7%; RR 0.58, 95% CI, 0.53-0.65, p<0.001) compared to standard group. Impact of triple group on late loss for in-stent (absolute reduction; 0.11 to 0.13 mm, p for interaction=0.97) and in-segment (absolute reduction; 0.13 to 0.15 mm, p for interaction=0.75) was consistent across stent type. Impact of triple group on in-segment restenosis was most prominent in SES (0.5% vs. 6.7%; RR 0.08; 95% CI, 0.02-0.34, p<0.001) than PES (14.4% vs. 20.2%; RR 0.71; 95% CI, 0.708-0.714, p<0.001) or ZES (12.2% vs. 20.0%, RR: 0.61, 95% CI: 0.39-0.96, p=0.028).
Triple group after DES significantly reduced restenosis by ≈40% compared to standard group in patients at high risk of restenosis. Triple group showed similar reduction of in-stent late loss by ≈0.12 mm regardless of stent type, which resulted in negligible restenosis rate (0.5%) in SES. Therefore, newer generation DES with performance comparable to SES might have prominent beneficial effect with triple therapy in term of angiographic restenosis.
Poster Sessions, Expo North
Monday, March 11, 2013, 9:45 a.m.-10:30 a.m.
Session Title: Therapeutic Approaches in Chronic CAD and Stable Ischemic Heart Disease
Abstract Category: 11. Chronic CAD/Stable Ischemic Heart Disease: Therapy
Presentation Number: 1281-62
- 2013 American College of Cardiology Foundation