title: Drug-eluting stenting followed by cilostazol treatment reduces late restenosis in patients with diabetes mellitus the DECLARE-DIABETES Trial (A Randomized Comparison of Triple Antiplatelet Therapy with Dual Antiplatelet Therapy After Drug-Eluting Stent Implantation in Diabetic Patients).
abstract: OBJECTIVE
  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.
authors: Asan Medical Center, University of Ulsan College of Medicine, Songpa-gu, Seoul, 138-736, Korea.
authors: Seung-Whan
authors: SW
authors: Lee
authors: Seong-Wook
authors: SW
authors: Park
authors: Young-Hak
authors: YH
authors: Kim
authors: Sung-Cheol
authors: SC
authors: Yun
authors: Duk-Woo
authors: DW
authors: Park
authors: Cheol Whan
authors: CW
authors: Lee
authors: Myeong-Ki
authors: MK
authors: Hong
authors: Hyun-Sook
authors: HS
authors: Kim
authors: Jae-Ki
authors: JK
authors: Ko
authors: Jae-Hyeong
authors: JH
authors: Park
authors: Jae-Hwan
authors: JH
authors: Lee
authors: Si Wan
authors: SW
authors: Choi
authors: In-Whan
authors: IW
authors: Seong
authors: Yoon Haeng
authors: YH
authors: Cho
authors: Nae-Hee
authors: NH
authors: Lee
authors: June Hong
authors: JH
authors: Kim
authors: Kook-Jin
authors: KJ
authors: Chun
authors: Seung-Jung
authors: SJ
authors: Park
mesh_terms: D000368:Aged; D001241:Aspirin / Q000008:administration & dosage; D000077407:Cilostazol; D000077144:Clopidogrel; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000628:therapy; D023903:Coronary Restenosis / Q000150:complications / Q000188:drug therapy*; D003331:Coronary Vessels / Q000187:drug effects*; D003920:Diabetes Mellitus; D003925:Diabetic Angiopathies / Q000150:complications*; D004359:Drug Therapy, Combination; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D006965:Hyperplasia; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage*; D013777:Tetrazoles / Q000008:administration & dosage*; D013988:Ticlopidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D016896:Treatment Outcome; D017539:Tunica Intima / Q000187:drug effects
chemical_list: D010975:Platelet Aggregation Inhibitors; D013777:Tetrazoles; D000077144:Clopidogrel; D000077407:Cilostazol; D013988:Ticlopidine; D001241:Aspirin