Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Am J Cardiol. 2013 Dec 1;112(11):1738-44. doi: 10.1016/j.amjcard.2013.08.008. Epub 2013 Sep 21.
There are no practical criteria for the use of triple antiplatelet therapy after drug-eluting stent (DES) implantation. In our present report, pooled analysis of 3 randomized studies in patients with diabetes mellitus (Drug-Eluting Stenting Followed by Cilostazol treatment reduces LAte Restenosis in patients with diabetes mellitus trial) and long coronary narrowings (Drug-Eluting Stenting Followed by Cilostazol Treatment Reduces Late Restenosis in Patients with Long Coronary Lesions trials I and II) compared triple (aspirin, clopidogrel, and cilostazol; triple group, n = 700) and dual antiplatelet therapies (aspirin and clopidogrel; dual group, n = 699) after DES implantation. Among pooled population (n = 1,399 patients), 1,173 patients with follow-up angiography were divided into 3 stent length categories (≤20, 20 to 40, and >40 mm). There was no statistical significance of in-stent restenosis (ISR) in ≤20- and 20- to 40-mm categories between 2 groups. However, ISR rate was significantly reduced in triple versus dual group in >40-mm stent length category (12.4% vs 22.1%, p = 0.008). In diabetic patients, triple group also showed significant reduction in the ISR rate in >40-mm stent length category (15.4% vs 32.3%, p = 0.003). According to postprocedural minimal lumen diameter, triple group showed a trend toward a lower ISR than that of the dual group in all categories (p = 0.033 for ≤2.5 mm, p = 0.087 for 2.5 to 3.0 mm, and p = 0.119 for >3.0 mm). In conclusion, the triple group had a significantly reduced ISR in patients with >40-mm stent length after DES implantation compared with the dual group. Therefore, this suggestion for use of triple antiplatelet therapy could be easily applied after DES implantation in routine clinical practice.
在药物洗脱支架（DES）植入后，没有使用三联抗血小板治疗的实用标准。在我们目前的报告中，对 3 项糖尿病患者随机研究（西洛他唑治疗减少糖尿病患者药物洗脱支架后晚期再狭窄试验）和长冠状动脉狭窄患者（西洛他唑治疗减少长冠状动脉病变患者药物洗脱支架后晚期再狭窄试验 I 和 II）的汇总分析比较了三联（阿司匹林、氯吡格雷和西洛他唑；三联组，n=700）和双联抗血小板治疗（阿司匹林和氯吡格雷；双联组，n=699）在 DES 植入后的疗效。在汇总人群（n=1399 例患者）中，1173 例患者进行了随访血管造影，分为 3 个支架长度类别（≤20、20 至 40 和>40 mm）。在≤20 和 20 至 40 mm 两个类别中，两组之间支架内再狭窄（ISR）无统计学意义。然而，在>40-mm 支架长度类别中，三联组的 ISR 发生率明显低于双联组（12.4%比 22.1%，p=0.008）。在糖尿病患者中，三联组在>40-mm 支架长度类别中也显著降低了 ISR 发生率（15.4%比 32.3%，p=0.003）。根据术后最小管腔直径，三联组在所有类别中均显示出低于双联组的 ISR 趋势（≤2.5 mm 时 p=0.033，2.5 至 3.0 mm 时 p=0.087，>3.0 mm 时 p=0.119）。总之，与双联组相比，三联组在 DES 植入后>40-mm 支架长度的患者中，ISR 明显降低。因此，在常规临床实践中，这种建议使用三联抗血小板治疗的方法可以很容易地应用于 DES 植入后。
