Department of Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
Am Heart J. 2010 Feb;159(2):284-291.e1. doi: 10.1016/j.ahj.2009.11.014.
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.
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.
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).
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.
西洛他唑可降低药物洗脱支架（DES）植入后的再狭窄和重复介入。然而，关于西洛他唑对 DES 植入后心脏事件的影响的数据很少。因此，我们评估了西洛他唑在成功接受 DES 植入的患者中的长期疗效和安全性。
对 3099 名成功接受 DES 植入的患者进行治疗，采用三联（阿司匹林、氯吡格雷和西洛他唑；三联组，n=1443）或双联（阿司匹林和氯吡格雷；双联组，n=1656）抗血小板治疗。我们使用整个队列的逆概率治疗加权（IPTW）和倾向评分匹配比较了 12 个月时的不良结局（死亡、心肌梗死[MI]或支架血栓形成）。
在 IPTW 调整后，两组间 12 个月的死亡率（风险比[HR]0.762，95%CI0.401-1.448，P=0.4062）无差异。然而，三联组 12 个月的 MI（HR0.233，95%CI0.077-0.703，P=0.0097）和支架血栓形成（HR0.136，95%CI0.035-0.521，P=0.0036）显著降低，而大出血无差异（HR0.969，95%CI0.443-2.119，P=0.9372）。在倾向评分匹配的队列（965 对）中，12 个月的临床结局与 IPTW 调整相似。在扩展的 Cox 模型中，三联抗血小板治疗的持续时间与支架血栓形成（HR0.056，95%CI0.003-0.916，P=0.0433）和 MI（HR0.749，95%CI0.568-0.988，P=0.0408）的降低相关。
与双联抗血小板治疗相比，DES 植入后三联抗血小板治疗可显著降低 12 个月时的支架血栓形成和 MI 风险，且不增加出血并发症的风险。DES 植入后三联治疗时间越长，支架血栓形成和 MI 的风险越低。
