title: A randomized comparison study assessing the impact of cilostazol on the heart rate and arrhythmias by 24-hour ambulatory holter electrocardiographic monitoring after drug-eluting stent implantation for coronary artery disease.
abstract: OBJECTIVE
  Cilostazol may have a positive chronotropic or pro-arrhythmic effect. However, there have been no randomized trials to confirm these effects.
  
  
  METHODS
  This randomized prospective trial compared dual (DAT, aspirin and clopidogrel, n=114) versus triple antiplatelet therapy (TAT, DAT plus cilostazol, n=113) at baseline and after six months in patients receiving intracoronary drug-eluting stents (DES). The primary endpoint was the 24-hour heart rate (24h-HR) at six months determined using 24h-Holter ECG monitoring. The secondary endpoints were the 24h-HR ≥70 bpm, 24h-HR increase ≥5 bpm and the counts or presence of arrhythmias.
  
  
  RESULTS
  At six months after DES implantation, the 24h-HR (73 [68-83] vs. 68 [62-75] bpm, p＜0.001), presence of a 24h-HR ≥70 bpm (71.4 vs. 47.1%, p＜0.001) and presence of a 24h-HR increase ≥5 bpm (44.8 vs. 24.5%, p=0.002) were significantly higher for the TAT group than for the DAT group. A multivariate analysis showed that the use of cilostazol (OR: 3.10, p=0.035) and a baseline 24h-HR ＜70 bpm (OR: 4.60, p＜0.001) were strong predictors of a 24h-HR increase ≥5 bpm. However, there were no significant intergroup differences in arrhythmias.
  
  
  CONCLUSIONS
  Cilostazol appears to result in an increase in the 24h-HR after DES implantation. Therefore, some caution should be exercised regarding the use of cilostazol in patients with tachycardia, when planning DES implantation.
authors.affiliation: Department of Cardiology, Seogwipo Medical Center, Jeju, Republic of Korea.
authors.forename: Beom-June
authors.initials: BJ
authors.lastname: Kwon
authors.forename: Su-Hyun
authors.initials: SH
authors.lastname: Lee
authors.forename: Dong-Bin
authors.initials: DB
authors.lastname: Kim
authors.forename: Hun-Jun
authors.initials: HJ
authors.lastname: Park
authors.forename: Sung-Won
authors.initials: SW
authors.lastname: Jang
authors.forename: Sang-Hyun
authors.initials: SH
authors.lastname: Ihm
authors.forename: Hee-Yeol
authors.initials: HY
authors.lastname: Kim
authors.forename: Ki-Bae
authors.initials: KB
authors.lastname: Seung
mesh_terms: D001145:Arrhythmias, Cardiac / Q000188:drug therapy*; D000077407:Cilostazol; D003324:Coronary Artery Disease / Q000188:drug therapy*; D004359:Drug Therapy, Combination; D054855:Drug-Eluting Stents; D015716:Electrocardiography, Ambulatory; D005260:Female; D005500:Follow-Up Studies; D006339:Heart Rate / Q000187:drug effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage*; D011446:Prospective Studies; D013777:Tetrazoles / Q000008:administration & dosage*; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors; D013777:Tetrazoles; D000077407:Cilostazol