Long-term effect of triple antiplatelet therapy for diabetic patients after percutaneous coronary intervention / 解放军医学杂志

ABSTRACT

Objective To evaluate the long-term effect and safety of triple antiplatelet therapy(cilostazol,aspirin and clopidogrel)for the patients with diabetes and acute coronary syndromes(ACS)undergoing percutaneous coronary intervention(PCI).Methods Between December 2004 and February 2006,a randomized,single center trial was conducted in General Hospital of Shenyang Command for comparison of dual and triple antiplatelet therapy after PCI for the patients with ACS.Of 263 diabetic patients enrolled in present study,122 were randomly assigned to standard dual antiplatelet treatment with aspirin and clopidogrel,141 were assigned to triple antiplatelet therapy with aspirin,clopidogrel and cilostazol.Primary endpoint was a composite of cardiac death,non-fatal myocardial infarction(MI),stroke or target vessel revascularization(TVR)at 1 year.Results Baseline clinical and angiographic characteristics were comparable between the two groups.No definite stent thrombosis or MI occurred in either group during the period of follow-up,and no significant difference existed yet in the rates of 1-year cardiac death(4.1% vs 1.5%,P=0.255),stroke(3.3% vs 0.7%,P=0.186)and TVR(12.3% vs 7.8%,P=0.223)between the patients received dual or triple antiplatelet therapy.The rate of primary events was 9.9%(14/141)in triple group,which was significantly lower than that in dual group [18.9%(23/122),P=0.038].Patients receiving hypoglycemic medicine got more benefits from triple antiplatelet treatment.There was no significant difference between the two antiplatelet regimens regarding the risk of hemorrhagic events and premature discontinuation of aspirin or clopidogrel.Conclusion The regimen of cilostazol plus aspirin and clopidogrel for diabetic patients undergoing PCI is effective and safe in reducing long-term adverse cardiac and cerebral-vascular events,especially for the patients with high dangerous DM complicated with ACS.