Triple antiplatelet therapy reduces ischemic events after drug-eluting stent implantation

Drug-Eluting stenting followed by Cilostazol treatment REduces Adverse Serious cardiac Events (DECREASE registry)

Seung Whan Lee, Seong Wook Park, Sung Cheol Yun, Young Hak Kim, Duk Woo Park, Won Jang Kim, Jong Young Lee, Cheol Whan Lee, Myeongki Hong, Jae Joong Kim, Seung Jung Park

Research output: Contribution to journalArticle

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Abstract

Background: Cilostazol has reduced restenosis and repeat intervention after drug-eluting stent (DES) implantation. However, there is little data regarding impact of cilostazol on cardiac events after DES implantation. Therefore, we assessed the long-term efficacy and safety of cilostazol in patients undergoing successful DES implantation. Methods: The patients (n = 3,099) undergoing successful DES implantation were treated with triple (aspirin, clopidogrel, and cilostazol; triple group, n = 1,443) or dual (aspirin and clopidogrel; dual group, n = 1,656) antiplatelet therapy. We compared adverse outcomes (death, myocardial infarction [MI], or stent thrombosis) at 12 months using the inverse probability of treatment weighted (IPTW) for the entire cohort and propensity score matching. Results: After IPTW adjustment, 12-month death (hazard ratio [HR] 0.762, 95% CI 0.401-1.448, P = .4062) was not different between the 2 groups. However, 12-month MI (HR 0.233, 95% CI 0.077-0.703, P = .0097) and stent thrombosis (HR 0.136, 95% CI 0.035-0.521, P = .0036) were significantly lower in triple group with no difference of major bleeding (HR 0.969, 95% CI 0.443-2.119, P = .9372). In the propensity score-matched cohort (965 pairs), 12-month clinical outcomes were similar to those of IPTW adjustment. On extended Cox model, duration of triple antiplatelet therapy was associated with reduction of stent thrombosis (HR 0.056, 95% CI 0.003-0.916, P = .0433) and MI (HR 0.749, 95% CI 0.568-0.988, P = .0408). Conclusions: Triple antiplatelet therapy significantly reduced 12-month risks of stent thrombosis and MI after DES implantation compared with dual antiplatelet therapy without increased risk of bleeding complications. The longer duration of triple therapy after DES implantation was associated with the lower risk of stent thrombosis and MI.

Original languageEnglish
JournalAmerican heart journal
Volume159
Issue number2
DOIs
Publication statusPublished - 2010 Jan 1

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Drug-Eluting Stents
Registries
clopidogrel
Stents
Thrombosis
Pharmaceutical Preparations
Myocardial Infarction
Propensity Score
Therapeutics
Aspirin
Hemorrhage
cilostazol
Proportional Hazards Models
Safety

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Lee, Seung Whan ; Park, Seong Wook ; Yun, Sung Cheol ; Kim, Young Hak ; Park, Duk Woo ; Kim, Won Jang ; Lee, Jong Young ; Lee, Cheol Whan ; Hong, Myeongki ; Kim, Jae Joong ; Park, Seung Jung. / Triple antiplatelet therapy reduces ischemic events after drug-eluting stent implantation : Drug-Eluting stenting followed by Cilostazol treatment REduces Adverse Serious cardiac Events (DECREASE registry). In: American heart journal. 2010 ; Vol. 159, No. 2.
@article{a4f4ee9a01254e329bfc53f3090b78bd,
title = "Triple antiplatelet therapy reduces ischemic events after drug-eluting stent implantation: Drug-Eluting stenting followed by Cilostazol treatment REduces Adverse Serious cardiac Events (DECREASE registry)",
abstract = "Background: Cilostazol has reduced restenosis and repeat intervention after drug-eluting stent (DES) implantation. However, there is little data regarding impact of cilostazol on cardiac events after DES implantation. Therefore, we assessed the long-term efficacy and safety of cilostazol in patients undergoing successful DES implantation. Methods: The patients (n = 3,099) undergoing successful DES implantation were treated with triple (aspirin, clopidogrel, and cilostazol; triple group, n = 1,443) or dual (aspirin and clopidogrel; dual group, n = 1,656) antiplatelet therapy. We compared adverse outcomes (death, myocardial infarction [MI], or stent thrombosis) at 12 months using the inverse probability of treatment weighted (IPTW) for the entire cohort and propensity score matching. Results: After IPTW adjustment, 12-month death (hazard ratio [HR] 0.762, 95{\%} CI 0.401-1.448, P = .4062) was not different between the 2 groups. However, 12-month MI (HR 0.233, 95{\%} CI 0.077-0.703, P = .0097) and stent thrombosis (HR 0.136, 95{\%} CI 0.035-0.521, P = .0036) were significantly lower in triple group with no difference of major bleeding (HR 0.969, 95{\%} CI 0.443-2.119, P = .9372). In the propensity score-matched cohort (965 pairs), 12-month clinical outcomes were similar to those of IPTW adjustment. On extended Cox model, duration of triple antiplatelet therapy was associated with reduction of stent thrombosis (HR 0.056, 95{\%} CI 0.003-0.916, P = .0433) and MI (HR 0.749, 95{\%} CI 0.568-0.988, P = .0408). Conclusions: Triple antiplatelet therapy significantly reduced 12-month risks of stent thrombosis and MI after DES implantation compared with dual antiplatelet therapy without increased risk of bleeding complications. The longer duration of triple therapy after DES implantation was associated with the lower risk of stent thrombosis and MI.",
author = "Lee, {Seung Whan} and Park, {Seong Wook} and Yun, {Sung Cheol} and Kim, {Young Hak} and Park, {Duk Woo} and Kim, {Won Jang} and Lee, {Jong Young} and Lee, {Cheol Whan} and Myeongki Hong and Kim, {Jae Joong} and Park, {Seung Jung}",
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Triple antiplatelet therapy reduces ischemic events after drug-eluting stent implantation : Drug-Eluting stenting followed by Cilostazol treatment REduces Adverse Serious cardiac Events (DECREASE registry). / Lee, Seung Whan; Park, Seong Wook; Yun, Sung Cheol; Kim, Young Hak; Park, Duk Woo; Kim, Won Jang; Lee, Jong Young; Lee, Cheol Whan; Hong, Myeongki; Kim, Jae Joong; Park, Seung Jung.

In: American heart journal, Vol. 159, No. 2, 01.01.2010.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Triple antiplatelet therapy reduces ischemic events after drug-eluting stent implantation

T2 - Drug-Eluting stenting followed by Cilostazol treatment REduces Adverse Serious cardiac Events (DECREASE registry)

AU - Lee, Seung Whan

AU - Park, Seong Wook

AU - Yun, Sung Cheol

AU - Kim, Young Hak

AU - Park, Duk Woo

AU - Kim, Won Jang

AU - Lee, Jong Young

AU - Lee, Cheol Whan

AU - Hong, Myeongki

AU - Kim, Jae Joong

AU - Park, Seung Jung

PY - 2010/1/1

Y1 - 2010/1/1

N2 - Background: Cilostazol has reduced restenosis and repeat intervention after drug-eluting stent (DES) implantation. However, there is little data regarding impact of cilostazol on cardiac events after DES implantation. Therefore, we assessed the long-term efficacy and safety of cilostazol in patients undergoing successful DES implantation. Methods: The patients (n = 3,099) undergoing successful DES implantation were treated with triple (aspirin, clopidogrel, and cilostazol; triple group, n = 1,443) or dual (aspirin and clopidogrel; dual group, n = 1,656) antiplatelet therapy. We compared adverse outcomes (death, myocardial infarction [MI], or stent thrombosis) at 12 months using the inverse probability of treatment weighted (IPTW) for the entire cohort and propensity score matching. Results: After IPTW adjustment, 12-month death (hazard ratio [HR] 0.762, 95% CI 0.401-1.448, P = .4062) was not different between the 2 groups. However, 12-month MI (HR 0.233, 95% CI 0.077-0.703, P = .0097) and stent thrombosis (HR 0.136, 95% CI 0.035-0.521, P = .0036) were significantly lower in triple group with no difference of major bleeding (HR 0.969, 95% CI 0.443-2.119, P = .9372). In the propensity score-matched cohort (965 pairs), 12-month clinical outcomes were similar to those of IPTW adjustment. On extended Cox model, duration of triple antiplatelet therapy was associated with reduction of stent thrombosis (HR 0.056, 95% CI 0.003-0.916, P = .0433) and MI (HR 0.749, 95% CI 0.568-0.988, P = .0408). Conclusions: Triple antiplatelet therapy significantly reduced 12-month risks of stent thrombosis and MI after DES implantation compared with dual antiplatelet therapy without increased risk of bleeding complications. The longer duration of triple therapy after DES implantation was associated with the lower risk of stent thrombosis and MI.

AB - Background: Cilostazol has reduced restenosis and repeat intervention after drug-eluting stent (DES) implantation. However, there is little data regarding impact of cilostazol on cardiac events after DES implantation. Therefore, we assessed the long-term efficacy and safety of cilostazol in patients undergoing successful DES implantation. Methods: The patients (n = 3,099) undergoing successful DES implantation were treated with triple (aspirin, clopidogrel, and cilostazol; triple group, n = 1,443) or dual (aspirin and clopidogrel; dual group, n = 1,656) antiplatelet therapy. We compared adverse outcomes (death, myocardial infarction [MI], or stent thrombosis) at 12 months using the inverse probability of treatment weighted (IPTW) for the entire cohort and propensity score matching. Results: After IPTW adjustment, 12-month death (hazard ratio [HR] 0.762, 95% CI 0.401-1.448, P = .4062) was not different between the 2 groups. However, 12-month MI (HR 0.233, 95% CI 0.077-0.703, P = .0097) and stent thrombosis (HR 0.136, 95% CI 0.035-0.521, P = .0036) were significantly lower in triple group with no difference of major bleeding (HR 0.969, 95% CI 0.443-2.119, P = .9372). In the propensity score-matched cohort (965 pairs), 12-month clinical outcomes were similar to those of IPTW adjustment. On extended Cox model, duration of triple antiplatelet therapy was associated with reduction of stent thrombosis (HR 0.056, 95% CI 0.003-0.916, P = .0433) and MI (HR 0.749, 95% CI 0.568-0.988, P = .0408). Conclusions: Triple antiplatelet therapy significantly reduced 12-month risks of stent thrombosis and MI after DES implantation compared with dual antiplatelet therapy without increased risk of bleeding complications. The longer duration of triple therapy after DES implantation was associated with the lower risk of stent thrombosis and MI.

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JO - American Heart Journal

JF - American Heart Journal

SN - 0002-8703

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