Cilostazol Added to Dual Antiplatelet Therapy for Patients with High Risk of Restenosis after Drug-Eluting Stent Implantation: A Systematic Review and Meta-Analysis of RCTs
Hai-Bin Chen, Xinlu Zhang, Hongbin Liang, Xuewei Liu and Jiancheng Xiu*
Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
- Corresponding Author:
- Jiancheng Xiu
Department of Cardiology
Nanfang Hospital, Southern Medical University
Guangzhou, Guangdong, 510515, China
E-mail: [email protected]
Received: February 13, 2015; Accepted: March 10, 2015; Published: March 15, 2015
Citation: Chen HB, Zhang X, Liang H, Liu X, Xiu J (2015) Cilostazol Added to Dual Antiplatelet Therapy for Patients with High Risk of Restenosis after Drug-Eluting Stent Implantation: A Systematic Review and Meta-Analysis of RCTs. Cardiol Pharmacol 4:133. doi: 10.4172/2329-6607.1000133
Copyright: © 2015 Chen HB et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Background: Cilostazol added to Dual Antiplatelet Therapy (DAT: aspirin, clopidogrel) reduces revascularization without increased bleeding in patients after Drug-Eluting Stent (DES) implantation. However, doubts remain about which patients benefit most from cilostazol-based Triple Antiplatelet Therapy (TAT) after DES.
Materials and Results: PubMed, EMBASE, CENTRAL databases were systematically searched. Randomized Controlled Trials (RCTs) comparing TAT and DAT for patients with high risk of restenosis (defined as obesity, diabetes, and long and/or multivessel coronary lesions) were included. Five RCTs were included, involving 2442 patients. The TAT group showed a significant reduction in MACEs (4.16% vs. 8.86%, RR: 0.47, 95% CI: 0.32 to 0.68, p<0.001), in-stent late loss (0.34 vs. 0.46, SMD: -0.22, 95% CI: -0.32 to -0.11, p<0.001), TVR (3.36% vs. 6.80%, RR: 0.49, 95% CI: 0.34 to 0.71, p<0.001), and in-stent restenosis (6.86% vs. 11.45%, RR: 0.60, 95% CI: 0.43 to 0.84, p=0.003) compared with the DAT group. There was no difference in all-cause mortality (1.56% vs. 0.82%, RR: 1.82, 95% CI: 0.87 to 3.77, p=0.110), bleeding (3.52% vs. 3.28%, RR: 1.07, 95% CI: 0.71 to 1.63, p=0.745) and stent thrombosis (0.82% vs. 0.66%, RR: 1.4, 95% CI: 0.50 to 3.06, p=0.641) between the two groups, whereas the incidence of other adverse reactions (11.38% vs. 6.39%, RR: 1.78, 95% CI: 1.37 to 2.33, p<0.001) and drug discontinuation (16.29% vs. 5.15%, RR: 4.60, 95% CI: 1.24 to 17.08, p=0.023) was greater in the TAT group than in the DAT group.
Conclusions: Compared with DAT, patients with a high risk of restenosis benefited from TAT in reduced stent restenosis and revascularization after DES implantation, without increases in all-cause mortality and bleeding, but accompanied by a higher incidence of other adverse reactions and drug discontinuation.