Abstract 918: Cilostazol is Associated with a Reduction in Angiographic Restenosis in Patients Undergoing Contemporary Stent based PCI: A Meta-Analysis of Randomized Controlled Trials
Early clinical trials comparing cilostazol with thienopyridines demonstrated increased stent thrombosis but a reduction in restenosis after coronary artery stenting. To evaluate the impact of cilostazol on restenosis in patients undergoing contemporary PCI with bare metal (BMS) or drug eluting stents (DES) and treated with aspirin and thienopyridine. Seven randomized trials (n=1852 patients) comparing triple therapy (aspirin, thienopyridine and cilostazol) with standard antiplatelet therapy were included. Summary risk ratios for restenosis, late loss, target lesion revascularization (TLR) and target vessel revascularization (TVR) were calculated using fixed-effects models. Cilostazol therapy was associated with a significant reduction in angiographic restenosis (risk ratio [RR] 0.59, 95% CI 0.48–0.73, p < 0.001) with consistent benefits in patients treated with BMS (RR 0.60, p < 0.001) or DES (RR 0.57, p = 0.003). Cilostazol was associated with a reduction in late loss in BMS (mean difference 0.24 mm, 95% CI 0.15–0.33, p < 0.001) and DES groups (mean difference 0.12 mm, 95% CI 0.06–0.18, p < 0.001) with a significant reduction in TLR (RR 0.39, 95% CI 0.24–0.64, p < 0.001), and with no difference in subacute stent thrombosis (RR 1.60, 95% CI 0.20–13.01, p = 0.66). Cilostazol in addition to existing antiplatelet therapy is associated with a reduction in angiographic restenosis in patients undergoing PCI with BMS or DES. This inexpensive drug may be particularly beneficial in patients who are at high risk of restenosis, and it should undergo further evaluation in large definitive randomized controlled trials.