Aims There is a paucity of data regarding the impact of adding cilostazol to dual antiplatelet therapy on the clinical outcomes after coronary bifurcation stenting in drug-eluting stent (DES) era. We sought to compare long-term safety and efficacy of triple anti-platelet therapy (TAPT) versus dual anti-platelet therapy (DAPT) in patients undergoing DES implantation for coronary bifurcation lesions.
Methods We evaluated 450 patients who underwent percutaneous coronary intervention (PCI) with DES for coronary bifurcation lesions with side branch diameter ��� 2.3mm from Sejong General Institute PCI database registry between April 2003 and December 2009. TAPT was defined as the addition of cilostazol for at least 3 months to conventional DAPT after PCI. The primary endpoint was major adverse cardiac events (MACE), defined as the composite outcomes of cardiac death, myocardial infarction and target lesion revascularization (TLR). The secondary endpoint was definite or probable stent thrombosis (ST). The safety endopoints were Thrombolysis In Myocardial Infarction (TIMI) major and minor bleeding.
Results Of the 450 total patients, 171 patients received TAPT and 279 patients received DAPT. During follow-up (median 46 months), MACE occurred in 51 patients (11.3 %); 21 (12.3%) in the TAPT group and 30 (10.8 %) in the DAPT group (P= 0.84). In multivariate analysis, TAPT was not associated with a lower incidence of MACE (hazard ratio [HR]: 0.69, 95% confidence interval [CI]: (0.38-1.25) and of cardiac death or MI (HR: 0.50, 95% CI: (0.20-1.25) and of TLR (HR: 1.16, 95% CI: (0.57-2.38). The use of cilostazol more than 6 months didn���t even change these results. The definite or probable ST occurred at a similar rate [2.3% (n=4) in the TAPT group and 1.8% (n=5) in the DAPT group, P=0.74]. The incidence of TIMI major bleeding was not significantly different among 2 groups [2.9% (n=5) in the TAPT group and 3.6% (n=10) in the DAPT group, P=0.71]. The incidence of TIMI minor bleeding was higher in TAPT group than DAPT group [8.8% (n=15) in the TAPT group and 2.9% (n=8) in the DAPT group, P=0.006].
Conclusions In our single- center registry data, TAPT in patients with bifurcation lesion treated with DES didn���t reduce the incidence of MACE or ST. In addition, bleeding tendency seemed to be increased in the TAPT group, compared with the DAPT group.
Key words • Cilostazol • Revascularization • Drug-eluting stents