Abstract 4181: Cilostazol Improves Long-term Survival After Endovascular Therapy in Hemodialysis Patients With Peripheral Artery Disease
Background: Cilostazol is a unique anti-platelet drug with vasodilatory effects and inhibits smooth muscle cell proliferation, and has been reported to reduce target lesion revascularization (TLR) after endovascular therapy (EVT) in general population with peripheral artery disease (PAD). It has been reported that cilostazol improves patency after EVT even in hemodialysis (HD) patients who are at high risk for arteriosclerosis, however, the effects of cilostazol for long-term survival remain unclear. The aim of this study was to clarify whether cilostazol improves long-term clinical outcome after EVT in HD patients with PAD.
Methods: Consecutive 258 HD patients with 492 lesions undergoing successfully PTA were enrolled. These patients were divided into two groups; the patients administered cilostazol (n=88) and those not administered cilostazol as a control (n=170), and were followed-up for 7 years. To minimize the selection bias for cilostazol administration, a propensity-matched analysis using the model includes male, age, traditional risk factors, ulcer/gangrene, TASC C+D type, femoropopliteal leiosns and stenting was performed. The propensity score in two groups was marched 1:1 with two-digit (AUC=0.64 using ROC analysis).
Results: Mean follow-up period was 39±33months. 7-year event-free survival was 69% and 51% for TLR (p=0.018), 88% and 75% for amputation (p=0.0086), 89% and 65% for cardiovascular (CV) mortality (p=0.0025) and 71% and 47% for all-cause mortality (p=0.0005) between cilostazol group and control group, respectively. Between 78 propensity-matched patients, event-free survival was similarly 67% and 47% for TLR (p=0.018), 87% and 72% for amputation (p=0.013), 81% and 69% for CV mortality (p=0.0047) and 64% and 45% for all-cause mortality (p=0.0048), respectively. After adjustment for other risk factors, cilostazol was independent predictor for preventing TLR (HR 0.57, 95%CI 0.32– 0.97, p=0.034), amputation (HR 0.35, 95%CI 0.14 – 0.87, p=0.026), CV mortality (HR 0.29, 95%CI 0.10 – 0.92, p=0.035) and all-cause mortality (HR 0.43, 95%CI 0.21– 0.87, p=0.019) after EVT, respectively.
Conclusion: Cilostazol administration not only reduces TLR but also improves long-term survival after EVT in HD patients with PAD.