Effects of long-term triple anti-platelet therapy with low-dose cilostazol after drug-eluting stent implantation / 대한내과학회지

ABSTRACT

BACKGROUND/AIMS: A recent clinical trial demonstrated that triple anti platelet therapy resulted in significantly larger minimal luminal diameter and lower restenosis rate compared with conventional therapy after bare metal stent (BMS) implantation. However, it is uncertain that this result will be repeated after drug eluting stent (DES) implantation, especially with low dose cilostazol therapy. Thus, we performed a prospective, randomized study to evaluate the effectiveness of long term triple therapy with low dose cilostazol after DES implantation. METHODS: We analyzed 109 patients (132 lesion) prospectively, who underwent successful coronary DES implantation. The patients were divided into two groups according to combined anti platelet regimen triple combination of aspirin, clopidogrel, and low dose cilostazol (50 mg/bid) (Group I, n=56) or dual combination of aspirin and clopidogrel (Group II, n=53) for 6 months. The minimal luminal diameter and binary restenosis rate were compared at 6 month follow up by coronary angiogram. The rates of stent thrombosis, major adverse cardiac events (MACE), and bleeding complication were also analyzed. RESULTS: The baseline clinical and angiographic characteristics were not different between the two groups. Angiographic follow-up was performed in 80 patients (109 lesions, 74%). The minimal luminal diameter at 6 month was 2.25+/-0.63 mm in group I and 2.30+/-0.56 mm in group II (p=0.742). Restenosis occurred in 4 patients (7.2%) in group I and 3 patients (5.6%) in group II (p=0.611). There were no differences in the rates of stent thrombosis, MACE, or bleeding complications between the two groups. CONCLUSIONS: Long term triple anti platelet therapy with low dose cilostazol after DES implantation was not effective in obtaining larger minimal luminal diameter or reducing restenosis rate, but it was used safely without increasing bleeding complication.