Comparison of Triple Antiplatelet Therapy and Dual Antiplatelet Therapy in Patients at High Risk of Restenosis After Drug-Eluting Stent Implantation (from the DECLARE-DIABETES and -LONG Trials)

Seung Whan Lee, Kook Jin Chun, Seong Wook Park, Hyun Sook Kim, Young Hak Kim, Sung Cheol Yun, Won Jang Kim, Jong Young Lee, Duk Woo Park, Cheol Whan Lee, Myeongki Hong, Kyoung Suk Rhee, Jei Keon Chae, Jae Ki Ko, Jae Hyeong Park, Jae Hwan Lee, Si Wan Choi, Jin Ok Jeong, In Whan Seong, Suh JonYoon Haeng Cho, Nae Hee Lee, June Hong Kim, Seung Jung Park

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Abstract

Although cilostazol has decreased restenosis and target lesion revascularization (TLR) after drug-eluting stent implantation, it is not known if this effect is durable at 2 years. We analyzed 2 randomized studies (Drug-Eluting stenting followed by Cilostazol treatment reduces LAte REstenosis in patients with DIABETES mellitus and Drug-Eluting Stenting Followed by Cilostazol treatment reduces LAte REstenosis in patients with LONG native coronary lesions trials) in which 900 patients were randomly assigned to triple antiplatelet therapy (aspirin, clopidogrel, and cilostazol; triple group, n = 450) and dual antiplatelet therapy (aspirin and clopidogrel; standard group, n = 450) for 6 months in patients with diabetes or long lesions receiving drug-eluting stents. We evaluated 2-year major adverse cardiac events (MACEs) including death, myocardial infarction (MI), and TLR. Nine-month TLRs and MACEs were significantly decreased in the triple versus standard group. At 2 years, the triple group sowed significantly decreased TLRs (4.2% vs 9.1%, hazard ratio 0.45, 95% confidence interval 0.26 to 0.78, p = 0.004) and MACEs (5.6% vs 10.4%, hazard ratio 0.52, 95% confidence interval 0.32 to 0.84, p = 0.008) compared to the standard group with no differences in death and MI. In subgroup analysis, triple antiplatelet therapy decrease of 2-year TLR was favorable in all subgroups, especially in patients with paclitaxel-eluting stents, diabetes mellitus, small vessels, long lesions, and left anterior descending coronary artery lesions. In conclusion, compared to the standard group, initial benefit in decreases of 9-month TLRs and MACEs in the triple group was sustained at 2 years with no differences in death or MI. Triple antiplatelet therapy decrease of 2-year TLR was favorable in all subgroups, especially in patients with high-risk profiles.

Original languageEnglish
Pages (from-to)168-173
Number of pages6
JournalAmerican Journal of Cardiology
Volume105
Issue number2
DOIs
Publication statusPublished - 2010 Jan 15

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

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    Lee, S. W., Chun, K. J., Park, S. W., Kim, H. S., Kim, Y. H., Yun, S. C., Kim, W. J., Lee, J. Y., Park, D. W., Lee, C. W., Hong, M., Rhee, K. S., Chae, J. K., Ko, J. K., Park, J. H., Lee, J. H., Choi, S. W., Jeong, J. O., Seong, I. W., ... Park, S. J. (2010). Comparison of Triple Antiplatelet Therapy and Dual Antiplatelet Therapy in Patients at High Risk of Restenosis After Drug-Eluting Stent Implantation (from the DECLARE-DIABETES and -LONG Trials). American Journal of Cardiology, 105(2), 168-173. https://doi.org/10.1016/j.amjcard.2009.08.667