Effects of Cilostazol on the Drug-Eluting Stent in Native Coronary Arteries

Background and Objectives:Cilostazol is an antiplatelet drug with antiproliferative properties when administered after coronary bare metal stent implantation. However, its effect on clinical and angiographic outcomes after sirolimus-eluting stent (SES) implantation in native coronary arteries has not been established. Subjects and Methods:Two hundred patients who had undergone successful SES implantation were randomly assigned to receive, in addition to aspirin, 75 mg clopidogrel daily or 100 mg cilostazol twice daily after one month of triple oral therapy (aspirin, clopidogrel, and cilostazol). The medications were continued until the follow-up coronary angiography, which was performed after six months. Results:There were no significant differences in the minimal luminal diameters before and immediately after the coronary intervention, and at the follow-up angiography. The late loss of minimal luminal diameter was 0.26±0.40 mm in the cilostazol group and 0.28±0.41 mm in the clopidogrel group (p=0.773). Other quantitative coronary angiography variables were also similar in the two groups. Restenosis, determined by quantitative coronary angiography at six months and defined as ≥30% narrowing, occurred in 11.4% of the clopidogrel group and 8.7% of the cilostazol group (p=0.478). However, in-stent restenosis was focal (100% vs 23.1% in the clopidogrel group, p<0.001), and shorter in the cilostazol group (6.26± 2.42 vs 14.5±6.55 mm, p=0.001). Conclusion:Cilostazol was not inferior to clopidogrel in terms of clinical anticoagulation effect, and had an antiproliferative effect in native coronary arteries after SES implantation. (Korean Circulation J 2007;37:304-311)