title: 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).
abstract: 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.
authors.affiliation: Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Seung-Whan
authors.initials: SW
authors.lastname: Lee
authors.forename: Kook-Jin
authors.initials: KJ
authors.lastname: Chun
authors.forename: Seong-Wook
authors.initials: SW
authors.lastname: Park
authors.forename: Hyun-Sook
authors.initials: HS
authors.lastname: Kim
authors.forename: Young-Hak
authors.initials: YH
authors.lastname: Kim
authors.forename: Sung-Cheol
authors.initials: SC
authors.lastname: Yun
authors.forename: Won-Jang
authors.initials: WJ
authors.lastname: Kim
authors.forename: Jong-Young
authors.initials: JY
authors.lastname: Lee
authors.forename: Duk-Woo
authors.initials: DW
authors.lastname: Park
authors.forename: Cheol Whan
authors.initials: CW
authors.lastname: Lee
authors.forename: Myeong-Ki
authors.initials: MK
authors.lastname: Hong
authors.forename: Kyoung-Suk
authors.initials: KS
authors.lastname: Rhee
authors.forename: Jei Keon
authors.initials: JK
authors.lastname: Chae
authors.forename: Jae-Ki
authors.initials: JK
authors.lastname: Ko
authors.forename: Jae-Hyeong
authors.initials: JH
authors.lastname: Park
authors.forename: Jae-Hwan
authors.initials: JH
authors.lastname: Lee
authors.forename: Si Wan
authors.initials: SW
authors.lastname: Choi
authors.forename: Jin-Ok
authors.initials: JO
authors.lastname: Jeong
authors.forename: In-Whan
authors.initials: IW
authors.lastname: Seong
authors.forename: Suh
authors.initials: S
authors.lastname: Jon
authors.forename: Yoon Haeng
authors.initials: YH
authors.lastname: Cho
authors.forename: Nae-Hee
authors.initials: NH
authors.lastname: Lee
authors.forename: June Hong
authors.initials: JH
authors.lastname: Kim
authors.forename: Seung-Jung
authors.initials: SJ
authors.lastname: Park
mesh_terms: 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
chemical_list: D010975:Platelet Aggregation Inhibitors; D013777:Tetrazoles; D000077144:Clopidogrel; D000077407:Cilostazol; D013988:Ticlopidine; D001241:Aspirin