Cilostazol eliminates adverse smoking outcome in patients with drug-eluting stent implantation.
BACKGROUND
The present study investigated whether cilostazol can eliminate adverse smoking outcome after percutaneous coronary intervention (PCI).


RESULTS
A total of 914 patients with successful drug-eluting stent (DES) implantation were randomly assigned to dual antiplatelet therapy (DAT; aspirin and clopidogrel, n=457) or to triple antiplatelet therapy (TAT; DAT with cilostazol, n=457). The effect of smoking on 2-year major adverse cardio/cerebrovascular events (MACCE) in both the TAT and DAT groups was evaluated. Total MACCE were not significantly different between the 2 anti-platelet regimens (9.8% in TAT vs. 11.4% in DAT groups, P=0.45), but the adverse effects of smoking on clinical outcome were different between DAT vs. TAT. Current smokers had a higher prevalence of MACCE than non-smokers in the DAT group (16.7% vs. 9.5%, P=0.04). In the TAT group, however, the adverse effect of smoking was abolished (9.2% vs. 10.1%, P=0.85). Regarding the effects of smoking on the antiplatelet effects of DAT or TAT, post-treatment platelet reactivity (in P2Y12 reaction units; PRU) in current smokers was not significantly lower than that in non-smokers in the DAT group, whereas, in the TAT group, it was significantly lower than that of non-smokers (189±88 vs. 216±89 PRU, P=0.01).


CONCLUSIONS
Adverse clinical effects of smoking may be eliminated by the addition of cilostazol to DAT after DES implantation. This may be due to the stimulation of cilostazol's antiplatelet effects by smoking.
Cardiovascular Center, Seoul National University Hospital.
Hack-Lyoung
HL
Kim
Jung-Won
JW
Suh
Seung-Pyo
SP
Lee
Hyun-Jae
HJ
Kang
Bon-Kwon
BK
Koo
Young-Seok
YS
Cho
Tae-Jin
TJ
Youn
In-Ho
IH
Chae
Dong-Ju
DJ
Choi
Seung-Woon
SW
Rha
Jang-Ho
JH
Bae
Taek-Geun
TG
Kwon
Jang-Whan
JW
Bae
Myeong-Chan
MC
Cho
Hyo-Soo
HS
Kim
D001993:Bronchodilator Agents / Q000008:administration & dosage*; D000077407:Cilostazol; D054855:Drug-Eluting Stents; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention; D012907:Smoking / Q000009:adverse effects* / Q000097:blood; D013777:Tetrazoles / Q000008:administration & dosage*
D001993:Bronchodilator Agents; D013777:Tetrazoles; D000077407:Cilostazol