Published Online
on October 24, 2005

A more recent version of this article appeared on November 1, 2005

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Submitted on January 5, 2005
Revised on August 3, 2005
Accepted on August 8, 2005

Coronary Stent Restenosis in Patients Treated With Cilostazol

John S. Douglas Jr MD^*, David R. Holmes Jr MD, Dean J. Kereiakes MD, Cindy L. Grines MD, Elizabeth Block BS, Ziyad M.B. Ghazzal MD, Douglas C. Morris MD, Henry Liberman MD, Karen Parker BS, Claudine Jurkovitz MD, Nancy Murrah BSN, Jovonne Foster MS, Pamela Hyde BSN, G. B. John Mancini MD, William S. Weintraub MD, for the Cilostazol for Restenosis Trial (CREST) Investigators

From the Emory University School of Medicine (J.S.D., E.B., Z.M.B.G., D.C.M., H.L., K.P., C.J., N.M., J.F., P.H., W.S.W.), Atlanta, Ga; the Mayo Clinic (D.R.H.), Rochester, Minn; the Lindner Clinical Trial Center and Ohio Heart Health Center (D.J.K.), Cincinnati, Ohio; the William Beaumont Hospital (C.L.G.), Royal Oak, Mich; and the University of British Columbia (G.B.J.M.), Vancouver, Canada.

^* To whom correspondence should be addressed. E-mail: john_douglas{at}emoryhealthcare.org.

Background--Restenosis after implantation of coronary artery stents remains a significant clinical problem. We undertook a randomized, double-blind, placebo-controlled trial to determine whether cilostazol, a drug that suppresses intimal proliferation, would reduce renarrowing in patients after stent implantation in native coronary arteries.

Methods and Results--We assigned 705 patients who had successful coronary stent implantation to receive, in addition to aspirin, cilostazol 100 mg BID or placebo for 6 months; clopidogrel 75 mg daily was administered to all patients for 30 days. Restenosis was determined by quantitative coronary angiography at 6 months. The minimal luminal diameter at 6 months for cilostazol-treated patients was 1.77 mm for the analysis segment (stent plus 5-mm borders) compared with 1.62 mm in the placebo group (P=0.01). Restenosis, defined as 50% narrowing, occurred in 22.0% of patients in the cilostazol group and in 34.5% of the placebo group (P=0.002), a 36% relative risk reduction. Restenosis was significantly lower in cilostazol-treated diabetics (17.7% versus 37.7%, P=0.01) and in those with small vessels (23.6% versus 35.2%, P=0.02), long lesions (29.9% versus 46.6%, P=0.04), and left anterior descending coronary artery site (19.3% versus 39.8%, P=0.001). There was no difference in bleeding, rehospitalization, target-vessel revascularization, myocardial infarction, or death.

Conclusions--Treatment with the drug cilostazol resulted in a significantly larger minimal luminal diameter and a significantly lower binary restenosis rate compared with placebo-treated patients. These favorable effects were apparent in patients at high risk for restenosis.

Key words: stents • restenosis • coronary disease • angioplasty

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