Comparison of Triple antiplatelet therapy and dual antiplatelet therapy in patients at high risk of restenosis after drug-eluting stent implantation (from the DECLARE-DIABETES and -LONG Trials).
Although cilostazol has decreased restenosis and target lesion revascularization (TLR) after drug-eluting stent implantation, it is not known if this effect is durable at 2 years. We analyzed 2 randomized studies (Drug-Eluting stenting followed by Cilostazol treatment reduces LAte REstenosis in patients with DIABETES mellitus and Drug-Eluting Stenting Followed by Cilostazol treatment reduces LAte REstenosis in patients with LONG native coronary lesions trials) in which 900 patients were randomly assigned to triple antiplatelet therapy (aspirin, clopidogrel, and cilostazol; triple group, n = 450) and dual antiplatelet therapy (aspirin and clopidogrel; standard group, n = 450) for 6 months in patients with diabetes or long lesions receiving drug-eluting stents. We evaluated 2-year major adverse cardiac events (MACEs) including death, myocardial infarction (MI), and TLR. Nine-month TLRs and MACEs were significantly decreased in the triple versus standard group. At 2 years, the triple group sowed significantly decreased TLRs (4.2% vs 9.1%, hazard ratio 0.45, 95% confidence interval 0.26 to 0.78, p = 0.004) and MACEs (5.6% vs 10.4%, hazard ratio 0.52, 95% confidence interval 0.32 to 0.84, p = 0.008) compared to the standard group with no differences in death and MI. In subgroup analysis, triple antiplatelet therapy decrease of 2-year TLR was favorable in all subgroups, especially in patients with paclitaxel-eluting stents, diabetes mellitus, small vessels, long lesions, and left anterior descending coronary artery lesions. In conclusion, compared to the standard group, initial benefit in decreases of 9-month TLRs and MACEs in the triple group was sustained at 2 years with no differences in death or MI. Triple antiplatelet therapy decrease of 2-year TLR was favorable in all subgroups, especially in patients with high-risk profiles.
Lee
Seung-Whan
SW
Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Chun
Kook-Jin
KJ
Park
Seong-Wook
SW
Kim
Hyun-Sook
HS
Kim
Young-Hak
YH
Yun
Sung-Cheol
SC
Kim
Won-Jang
WJ
Lee
Jong-Young
JY
Park
Duk-Woo
DW
Lee
Cheol Whan
CW
Hong
Myeong-Ki
MK
Rhee
Kyoung-Suk
KS
Chae
Jei Keon
JK
Ko
Jae-Ki
JK
Park
Jae-Hyeong
JH
Lee
Jae-Hwan
JH
Choi
Si Wan
SW
Jeong
Jin-Ok
JO
Seong
In-Whan
IW
Jon
Suh
S
Cho
Yoon Haeng
YH
Lee
Nae-Hee
NH
Kim
June Hong
JH
Park
Seung-Jung
SJ
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D001241:Aspirin / Q000008:administration & dosage*; D000077407:Cilostazol; D000077144:Clopidogrel; D023903:Coronary Restenosis / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D048909:Diabetes Complications / Q000150:complications / Q000473:pathology / Q000628:therapy; D004359:Drug Therapy, Combination; D054855:Drug-Eluting Stents; D005260:Female; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control; D006801:Humans; 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
D010975:Platelet Aggregation Inhibitors; D013777:Tetrazoles; D000077144:Clopidogrel; D000077407:Cilostazol; D013988:Ticlopidine; D001241:Aspirin