Long-term clinical efficacy and safety of adding cilostazol to dual antiplatelet therapy after drug-eluting stent implantation in coronary arteries: A meta-analysis of randomized controlled trials.
OBJECTIVE
To assess the long-term clinical efficacy and safety of adding cilostazol (TAT) to conventional dual antiplatelet therapy (DAT) for patients undergoing drug-eluting stent (DES) implantation in coronary arteries.


METHODS
We performed PUBMED, MEDLINE, EMBASE, and Cochrane CENTRAL searches for randomized clinical trials of TAT versus DAT in patients after DES implantation with criteria to include trials with a follow-up of more than 6 months.


RESULTS
Seven RCTs with a total of 3487 patients were included in this review. The meta-analysis showed that TAT was associated with a significant reduction in major adverse cardiac events (MACEs) (relative risk (RR)=0.66; 95% CI=0.50-0.88), target lesion revascularization (TLR) (RR=0.61, 95% CI=0.43-0.84), target vessel revascularization (TVR) (RR=0.53, 95% CI=0.37-0.75), in-stent restenosis (RR=0.64, 95% CI=0.44-0.85), in-segment restenosis (RR=0.58, 95% CI=0.43-0.79, P<.01), in-stent late loss (LL) (standardized mean difference (SMD)=-0.21, 95% CI=0.32-0.17), and in-segment LL (SMD=-0.27, 95% CI=-0.38-0.16). TAT also did not appear to significantly alter any of the other meta-analysis secondary efficacy outcomes and had similar rates of bleeding, but TAT had significantly higher rates of rash, gastrointestinal side-effects, headache and drug discontinuation.


CONCLUSIONS
Compared with standard DAT, the long-term use of TAT in patients after DES implantation gave more benefits in reducing the incidence of MACEs, TLR, TVR, in-stent and in-segment LL and restenosis without increasing bleeding but was associated with an increase in minor adverse events.
Department of Cardiology, The First Affiliated Hospital, Jinan University, Guangzhou, Guangdong, China; Internal Medicine, Guangdong Women And Children Hospital, Guangzhou, Guangdong, China.
Yandun
Y
Zou
Internal Medicine, Guangdong Women And Children Hospital, Guangzhou, Guangdong, China.
Chunling
C
Hu
Internal Medicine, Guangdong Women And Children Hospital, Guangzhou, Guangdong, China.
Wenhui
W
Ye
Internal Medicine, Guangdong Women And Children Hospital, Guangzhou, Guangdong, China.
Limei
L
Fan
Department of Cardiology, The First Affiliated Hospital, Jinan University, Guangzhou, Guangdong, China.
Likun
L
Xu
Department of Cardiology, The First Affiliated Hospital, Jinan University, Guangzhou, Guangdong, China. Electronic address: aidongzhang11@163.com.
Aidong
A
Zhang
D000077407:Cilostazol; D003331:Coronary Vessels / Q000473:pathology; D054855:Drug-Eluting Stents; D006801:Humans; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000009:adverse effects; D016032:Randomized Controlled Trials as Topic; D013777:Tetrazoles; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000008:administration & dosage* / Q000009:adverse effects
D010975:Platelet Aggregation Inhibitors; D013777:Tetrazoles; D014665:Vasodilator Agents; D000077407:Cilostazol
Cilostazol; Drug-eluting stent; Dual antiplatelet therapy; Triple antiplatelet therapy