Comparison of 1-Year Outcomes of Triple (Aspirin?+?Clopidogrel?+?Cilostazol) Versus Dual Antiplatelet Therapy (Aspirin?+?Clopidogrel?+?Placebo) After Implantation of Second-Generation Drug-Eluting Stents into One or More Coronary Arteries: from the DECREASE-PCI Trial - 28/02/18
, Hyun-Sook Kim, MD d, ** , Young Jin Choi, MD e, Chang-Wook Nam, MD f, Jang Hyun Cho, MD g, Won-Yong Shin, MD h, Jae Bin Seo, MD i, Si Wan Choi, MD j, Jae-Hwan Lee, MD j, Pil-Ki Min, MD k, Sung-Ho Her, MD l, Pil Hyung Lee, MD a, Jung-Min Ahn, MD a, Duk-Woo Park, MD a, Soo-Jin Kang, MD a, Young-Hak Kim, MD a, Cheol Whan Lee, MD a, Seong-Wook Park, MD a, Seung-Jung Park, MD aAbstract |
This study sought to evaluate the impact of triple antiplatelet therapy on clinical outcomes in patients treated with second-generation drug-eluting stents (DES) for coronary artery disease. There are limited data regarding the impact of triple antiplatelet therapy in patients who underwent implantation of second-generation DES. We planned to randomly assign 2,110 patients treated with second-generation DES to triple (aspirin, clopidogrel, and cilostazol) and dual (aspirin, clopidogrel, and placebo) antiplatelet therapy groups. The primary end point was a composite of death, myocardial infarction, ischemic stroke, or target vessel revascularization (TVR) at 1 year since randomization. The study was stopped early owing to slow enrollment. In total, 404 patients (202 patients each in the triple and dual antiplatelet therapy groups) were finally enrolled. At 1 year, the primary end point had occurred in 3.6% and 9.4% of patients in the triple and dual antiplatelet therapy groups, respectively (hazard ratio [HR] of the triple group 0.396; 95% confidence interval [CI] 0.166 to 0.949; p = 0.038). There was no significant difference between the 2 groups regarding the occurrence of a composite of all-cause death, myocardial infarction, or ischemic stroke (HR 0.583; 95% CI 0.229 to 1.481; p = 0.256). However, the rates of TVR were significantly lower in the triple antiplatelet therapy group than in the dual antiplatelet therapy group (HR 0.118; 95% CI 0.015 to 0.930; p = 0.043). In conclusion, triple antiplatelet therapy with cilostazol after implantation of second-generation DES improved clinical outcomes, mainly by reducing TVR.
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| Funding sources: The DECREASE-PCI trial was supported by Korea Otsuka Pharmaceutical Co., Ltd., Seoul, Korea (funding source) and the Cardiovascular Research Foundation, Seoul, Korea. Korea Otsuka Pharmaceutical Co., Ltd., had no role in the study design, data collection, data analysis, or data interpretation; access to the clinical trial database; or the opportunity to review or comment on the report. |
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| C.H. Lee and J.-Y. Lee contributed equally to this article. |
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| See page 428 for disclosure information. |
Vol 121 - N° 4
P. 423-429 - février 2018 Retour au numéro
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