Comparison of dual versus triple antiplatelet therapy after drug-eluting stent according to stent length (from the pooled analysis of DECLARE trials).
There are no practical criteria for the use of triple antiplatelet therapy after drug-eluting stent (DES) implantation. In our present report, pooled analysis of 3 randomized studies in patients with diabetes mellitus (Drug-Eluting Stenting Followed by Cilostazol treatment reduces LAte Restenosis in patients with diabetes mellitus trial) and long coronary narrowings (Drug-Eluting Stenting Followed by Cilostazol Treatment Reduces Late Restenosis in Patients with Long Coronary Lesions trials I and II) compared triple (aspirin, clopidogrel, and cilostazol; triple group, n = 700) and dual antiplatelet therapies (aspirin and clopidogrel; dual group, n = 699) after DES implantation. Among pooled population (n = 1,399 patients), 1,173 patients with follow-up angiography were divided into 3 stent length categories (≤20, 20 to 40, and >40 mm). There was no statistical significance of in-stent restenosis (ISR) in ≤20- and 20- to 40-mm categories between 2 groups. However, ISR rate was significantly reduced in triple versus dual group in >40-mm stent length category (12.4% vs 22.1%, p = 0.008). In diabetic patients, triple group also showed significant reduction in the ISR rate in >40-mm stent length category (15.4% vs 32.3%, p = 0.003). According to postprocedural minimal lumen diameter, triple group showed a trend toward a lower ISR than that of the dual group in all categories (p = 0.033 for ≤2.5 mm, p = 0.087 for 2.5 to 3.0 mm, and p = 0.119 for >3.0 mm). In conclusion, the triple group had a significantly reduced ISR in patients with >40-mm stent length after DES implantation compared with the dual group. Therefore, this suggestion for use of triple antiplatelet therapy could be easily applied after DES implantation in routine clinical practice.
Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Seung-Whan
SW
Lee
Jong-Young
JY
Lee
Jung-Min
JM
Ahn
Duk-Woo
DW
Park
Seungbong
S
Han
Yong Kyu
YK
Park
Woo Seok
WS
Lee
Jeong Yoon
JY
Jang
Chang Hee
CH
Kwon
Gyung-Min
GM
Park
Young-Rak
YR
Cho
Won-Jang
WJ
Kim
Soo-Jin
SJ
Kang
Young-Hak
YH
Kim
Cheol Whan
CW
Lee
Jae-Joong
JJ
Kim
Seong-Wook
SW
Park
Seung-Jung
SJ
Park
D000368:Aged; D001241:Aspirin / Q000627:therapeutic use*; D000077407:Cilostazol; D000077144:Clopidogrel; D003324:Coronary Artery Disease / Q000150:complications / Q000188:drug therapy* / Q000601:surgery; D023903:Coronary Restenosis / Q000517:prevention & control*; D048909:Diabetes Complications / Q000188:drug therapy* / Q000601:surgery; D004359:Drug Therapy, Combination / Q000379:methods; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D019919:Prosthesis Implantation; D013777:Tetrazoles / Q000627:therapeutic use*; D013988:Ticlopidine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D016896:Treatment Outcome
D010975:Platelet Aggregation Inhibitors; D013777:Tetrazoles; D000077144:Clopidogrel; D000077407:Cilostazol; D013988:Ticlopidine; D001241:Aspirin