JACC: Triple-antiplatelet therapy after DES may improve outcomes
Patients receiving triple-antiplatelet therapy after long zotarolimus-eluting stent implantation had decreased extent of late luminal loss, percent intimal hyperplasia volume and angiographic restenosis, resulting in a reduced risk of one-year target lesion revascularization (TLR) compared with patients receiving dual-antiplatelet therapy, according to the DECLARE-LONG trial in the March 15 issue of the Journal of the American College of Cardiology.
Restenosis after drug-eluting stent (DES) implantation remains a significant clinical problem in long coronary lesions, so the researchers sought to determine whether cilostazol (Pletal, Otsuka Pharmaceutical) reduces intimal hyperplasia in patients undergoing long zotarolimus-eluting stent (Endeavor, Medtronic) implantation (stent length: >30 mm) for native long coronary lesions (length: >25 mm).
Seung-Whan Lee, MD, from the Asan Medical Center, University of Ulsan College of Medicine in Seoul, South Korea, and colleagues randomly assigned 499 patients to triple (aspirin, clopidogrel and cilostazol, triple group: 250 patients) or dual-antiplatelet therapy (aspirin and clopidogrel and placebo, dual group: 249 patients) for eight months after long zotarolimus-eluting stent implantation.
The primary endpoint was in-stent late loss at eight-month angiography exam according to the intention-to-treat principle.
The two groups had similar baseline characteristics. The in-stent (0.56 mm vs. 0.68 mm) and in-segment (0.32 mm vs. 0.47 mm) late loss were significantly lower in the triple versus dual group, as were eight-month in-stent restenosis (10.8 vs. 19.1 percent), in-segment restenosis (12.2 vs. 20 percent).
They also found that one-year ischemic-driven TLRs were decreased by 48 percent in the triple group.
At 12 months, Lee and colleagues reported that the major adverse cardiac events including death, MI and ischemic-driven target lesion revascularization tended to be lower in the triple group than the dual group (7.2 vs. 12 percent). Percent intimal hyperplasia volume by volumetric intravascular ultrasound analysis was reduced from 27.1 percent for the dual group to 22.1 percent for the triple group.
The researchers noted that the triple group had a higher rate of drug discontinuation than the dual group, but there were similar episodes of bleeding complications. “Moreover, significant adverse drug events were not detected in the triple group, suggesting that patients undergoing coronary stenting can be treated safely with the triple-antiplatelet regimen,” they wrote.
According Lee et al, their findings suggested that adding cilostazol on standard care improved the efficacy of DES in patients or lesions at high risk for restenosis in routine practice.
Restenosis after drug-eluting stent (DES) implantation remains a significant clinical problem in long coronary lesions, so the researchers sought to determine whether cilostazol (Pletal, Otsuka Pharmaceutical) reduces intimal hyperplasia in patients undergoing long zotarolimus-eluting stent (Endeavor, Medtronic) implantation (stent length: >30 mm) for native long coronary lesions (length: >25 mm).
Seung-Whan Lee, MD, from the Asan Medical Center, University of Ulsan College of Medicine in Seoul, South Korea, and colleagues randomly assigned 499 patients to triple (aspirin, clopidogrel and cilostazol, triple group: 250 patients) or dual-antiplatelet therapy (aspirin and clopidogrel and placebo, dual group: 249 patients) for eight months after long zotarolimus-eluting stent implantation.
The primary endpoint was in-stent late loss at eight-month angiography exam according to the intention-to-treat principle.
The two groups had similar baseline characteristics. The in-stent (0.56 mm vs. 0.68 mm) and in-segment (0.32 mm vs. 0.47 mm) late loss were significantly lower in the triple versus dual group, as were eight-month in-stent restenosis (10.8 vs. 19.1 percent), in-segment restenosis (12.2 vs. 20 percent).
They also found that one-year ischemic-driven TLRs were decreased by 48 percent in the triple group.
At 12 months, Lee and colleagues reported that the major adverse cardiac events including death, MI and ischemic-driven target lesion revascularization tended to be lower in the triple group than the dual group (7.2 vs. 12 percent). Percent intimal hyperplasia volume by volumetric intravascular ultrasound analysis was reduced from 27.1 percent for the dual group to 22.1 percent for the triple group.
The researchers noted that the triple group had a higher rate of drug discontinuation than the dual group, but there were similar episodes of bleeding complications. “Moreover, significant adverse drug events were not detected in the triple group, suggesting that patients undergoing coronary stenting can be treated safely with the triple-antiplatelet regimen,” they wrote.
According Lee et al, their findings suggested that adding cilostazol on standard care improved the efficacy of DES in patients or lesions at high risk for restenosis in routine practice.