Abstract 3039: Addition of Cilostazol to Aspirin and a Thienopyridine for Prevention of Restenosis After Coronary Artery Stenting: A Meta-Analysis
The use of metallic stents has significantly improved outcomes in patients undergoing percutaneous coronary intervention. Current guidelines recommend dual anti-platelet therapy (thienopyridine and aspirin) for 12 months after coronary stenting to prevent thrombosis. In addition to thrombosis, restenosis remains a significant complication, with 6 month rates as high as 10 percent despite the use of modern techniques and drug-eluting stents (DES). Cilostazol, a phosphodiesterase III inhibitor, reduces neointimal hyperplasia and lowers restenosis rates after stent implantation. In order to further evaluate the benefit of adding cilostazol to dual anti-platelet therapy, we performed a meta-analysis of randomized trials comparing three drug regimens (cilostazol, thienopyridine, aspirin [triple therapy]) with dual anti-platelet therapy after coronary stenting. A systematic search was conducted of Medline, Cinahl and Embase, Eligible trials had to be randomized, controlled, parallel studies comparing triple versus dual therapy and report data on angiographic restenosis. The primary endpoint was the rate of 6 month restenosis, as defined by ≥50 percent narrowing on angiography. Secondary endpoints included minimum luminal diameter (MLD), major adverse cardiac events (MACE), and bleeding rates. A total of 5 studies were included in the analysis. Triple therapy was used in 796 patients while dual therapy was used in 801 patients. Approximately 56 percent of patients received a DES. The 6 month restenosis rates were significantly lower with triple versus dual anti-platelet therapy (12.7 versus 21.9 percent; OR 0.5; 95% CI 0.38 to 0.66; p<0.001). This benefit was seen regardless of whether the stent was bare metal or drug-eluting. Furthermore the MLD was significantly higher in the cilostazol group [mean (mm) 0.18; 95% CI 0.1 to 0.27; p<0.001]. MACE and bleeding rates were reported for 3 of the 5 studies (n = 1426); analysis of these outcomes showed no difference between groups (p=0.21 and 0.48, respectively). The addition of cilostazol to standard dual anti-platelet therapy reduces angiographic restenosis and increases MLD at 6 months without significantly impacting rates of MACE or bleeding.