Korean Circ J.  2007 Jul;37(7):304-311. 10.4070/kcj.2007.37.7.304.

Effects of Cilostazol on the Drug-Eluting Stent in Native Coronary Arteries

Affiliations
  • 1The Department of Internal Medicine, Cardiology Division, Inje University College of Medicine, Busan, Korea. jo1216@chollian.net

Abstract

BACKGROUND AND OBJECTIVES: Cilostazol is an antiplatelet drug with antiproliferative properties when administered after coronary bare metal stent implantation. However, its effect on clinical and angiographic outcomes after sirolimus-eluting stent (SES) implantation in native coronary arteries has not been established.
SUBJECTS AND METHODS
Two hundred patients who had undergone successful SES implantation were randomly assigned to receive, in addition to aspirin, 75 mg clopidogrel daily or 100 mg cilostazol twice daily after one month of triple oral therapy (aspirin, clopidogrel, and cilostazol). The medications were continued until the follow-up coronary angiography, which was performed after six months.
RESULTS
There were no significant differences in the minimal luminal diameters before and immediately after the coronary intervention, and at the follow-up angiography. The late loss of minimal luminal diameter was 0.26+/-0.40 mm in the cilostazol group and 0.28+/-0.41 mm in the clopidogrel group (p=0.773). Other quantitative coronary angiography variables were also similar in the two groups. Restenosis, determined by quantitative coronary angiography at six months and defined as > or =30% narrowing, occurred in 11.4% of the clopidogrel group and 8.7% of the cilostazol group (p=0.478). However, in-stent restenosis was focal (100% vs 23.1% in the clopidogrel group, p<0.001), and shorter in the cilostazol group (6.26+/-2.42 vs 14.5+/-6.55 mm, p=0.001).
CONCLUSION
Cilostazol was not inferior to clopidogrel in terms of clinical anti-coagulation effect, and had an antiproliferative effect in native coronary arteries after SES implantation.

Keyword

Cilostazol; Clopidogrel; Sirolimus; Stents; Coronary restenosis

MeSH Terms

Angiography
Aspirin
Coronary Angiography
Coronary Restenosis
Coronary Vessels*
Drug-Eluting Stents*
Follow-Up Studies
Humans
Phenobarbital
Sirolimus
Stents
Aspirin
Phenobarbital
Sirolimus

Figure

  • Fig. 1 Cumulative distribution curves for the minimal luminal diameter (MLD) of the target coronary lesions at pre-intervention (closed triangles), post-intervention (closed squares), and follow-up coronary angiography (open circles) for the clopidogrel and cilostazol treatment groups.


Reference

1. Serruys PW, de Jaegere P, Kiemeneij F, et al. A comparison of balloon-expandable-stent implantation with balloon angioplasty in patients with coronary artery disease. N Engl J Med. 1994. 331:489–495.
2. Fischman DL, Leon MB, Baim D, et al. A randomized comparison of coronary-stent placement and balloon angioplasty in the treatment of coronary artery disease. N Engl J Med. 1994. 331:496–501.
3. Moses JW, Leon MB, Popma JJ, et al. Sirolimus-eluting stents versus standard stents in patients with stenosis in a native coronary artery. N Engl J Med. 2003. 349:1315–1323.
4. Babapulle MN, Joseph L, Belisle P, Brophy JM, Eisenberg MJ. A hierarchical Bayesian meta-analysis of randomised clinical trials of drug-eluting stents. Lancet. 2004. 364:583–591.
5. Sawhney N, Moses JW, Leon MB, et al. Treatment of left anterior descending coronary artery disease with sirolimus-eluting stents. Circulation. 2004. 110:374–379.
6. Chu YH, Park SW, Lee CW, et al. Effects of cilostazol treatment on angiographic restenosis after coronary stent placement. Korean Circ J. 2000. 30:1494–1500.
7. Tuschikane E, Fukuhara A, Kobayashi T, et al. Impact of cilostazol on restenosis after percutaneous coronary balloon angioplasty. Circulation. 1999. 100:21–26.
8. Kamishirado H, Inoue T, Mizoguchi K, et al. Randomized comparison of cilostazol versus ticlopidine hydrochloride for antiplatelet therapy after coronary stent implantation for prevention of late restenosis. Am Heart J. 2002. 144:303–308.
9. Byun KH, Shim JK, Min SJ, Jeon SJ, Kim JH. The multiple combined oral platelet aggregation inhibitors of aspirin, ticlopidine and cilostazl after PCI. Korean Circ J. 2004. 34:443–450.
10. Mintz GS, Popma JJ, Pichard AD, et al. Arterial remodeling after coronary angioplasty: a serial intravascular ultrasound study. Circulation. 1996. 94:35–43.
11. Cohen HA, Williams DO, Holmes DR, et al. Use of drug-eluting stents in contemporary interventions: a comparison to bare metal stent use in the National Heart, Lung, and Blood Institute Dynamic Registry. J Am Coll Cardiol. 2005. 45:Suppl A. 63A. Abstract.
12. Stone GW, Ellis SG, Cox DA, et al. A polymer-based, paclitaxel-eluting stent in patients with coronary artery disease. N Engl J Med. 2004. 350:221–231.
13. Kong DF, Eisenstein EL, Sketch MH, et al. Economic impact of drug-eluting stents on hospital systems: a disease-state model. Am Heart J. 2004. 147:449–456.
14. Cohen DJ, Bakhai A, Shi C, et al. Cost-effectiveness of sirolimus-eluting stents for treatment of complex coronary stenoses: results from the sirolimus-eluting balloon expandable stent in the treatment of patients with de novo native coronary artery lesions (SIRIUS) trial. Circulation. 2004. 110:508–514.
15. Mehran R, Dangas G, Abizaid AS, et al. Angiographic patterns of in-stent restenosis: classification and implications for the long-term outcome. Circulation. 1999. 100:1872–1878.
16. Nishi T, Tabusa F, Tanaka T, et al. Studies on 2-oxoquinoline derivatives as blood platelet aggregation inhibitors: II. 6-[3-(1-cyclohexyl-5-tetrazolyl) propoxy]-1,2-dihydro-2-oxoquinoline and related compounds. Chem Pharm Bull. 1983. 31:1151–1157.
17. Akiyama H, Kubo S, Shimizu T. The absorption, distribution and excretion of a new antithrombotic and vasodilating agent, cilostazol, in rat, rabbit, dog and man. Arzneimittelforschung. 1985. 35:1124–1132.
18. Kimura Y, Tani T, Kanbe T, Watanabe K. Effect of cilostazol on platelet aggregation and experimental thrombosis. Arzneimttelforschung. 1985. 35:1144–1149.
19. van Domburg RT, Foley DP, de Jaegere PP, et al. Long term outcome after coronary stent implantation: a 10 year single centre experience of 1000 patients. Heart. 1999. 82:Suppl II. II27–II34.
20. Lee KJ, Yun SW, Kim SW, Kim TH, Kim CJ, Ryu WS. The effects of cilostazol on proliferation of vascular smooth muscle cells and expression of iNOS and p21. Korean Circ J. 2004. 34:500–506.
21. Gawaz M, Neumann FJ, Ott I, May A, Schomig A. Platelet activation and coronary stent implantation: effect of antithrombic therapy. Circulation. 1996. 94:279–285.
22. Mickelson JK, Lakkis NM, Villarreal-Levy G, Jughes BJ, Smith CW. Leukocyte activation with platelet adhesion after coronary angioplasty: a mechanism for recurrent disease? J Am Coll Cardiol. 1996. 28:345–353.
23. Neuman FJ, Ott I, Gawaz M, Puchner G, Schomig A. Neutrophil and platelet activation at balloon-injured coronary artery plaque in patients undergoing angioplasty. J Am Coll Cardiol. 1996. 27:819–824.
24. Inoue T, Sakai Y, Hoshi K, Yaguchi I, Fujito T, Morooka S. Lower expression of neutrophil adhesion molecule indicates less vessel wall injury and might explain lower restenosis rate after cutting balloon angioplasty. Circulation. 1998. 97:2511–2518.
25. Inoue T, Sakai Y, Fujito T, et al. Expression of activation-dependent platelet membrane protein after coronary stenting: a comparison with balloon angioplasty. Circulation. 1996. 94:Suppl I. I260.
26. Inoue T, Sohma R, Morooka S. Cilostazol inhibits the expression of activation-dependent membrane surface glycoprotein on the surface of platelets stimulated in vitro. Thromb Res. 1999. 93:137–143.
27. Inoue T, Uchida T, Sakuma M, et al. Cilostazol inhibits leukocyte integrin Mac-1, leading to a potential reduction in restenosis after coronary stent implantation. J Am Coll Cardiol. 2004. 44:1408–1414.
28. Takahashi S, Oida K, Fujiwara R, et al. Effect of cilostazol, a cyclic AMP phosphodiesterase inhibitor, on the proliferation of rat aortic smooth muscle cells in culture. J Cardiovasc Pharmacol. 1992. 20:900–906.
Full Text Links
  • KCJ
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr