Document Detail


Comparison of Triple antiplatelet therapy and dual antiplatelet therapy in patients at high risk of restenosis after drug-eluting stent implantation (from the DECLARE-DIABETES and -LONG Trials).
MedLine Citation:
PMID:  20102913     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Although cilostazol has decreased restenosis and target lesion revascularization (TLR) after drug-eluting stent implantation, it is not known if this effect is durable at 2 years. We analyzed 2 randomized studies (Drug-Eluting stenting followed by Cilostazol treatment reduces LAte REstenosis in patients with DIABETES mellitus and Drug-Eluting Stenting Followed by Cilostazol treatment reduces LAte REstenosis in patients with LONG native coronary lesions trials) in which 900 patients were randomly assigned to triple antiplatelet therapy (aspirin, clopidogrel, and cilostazol; triple group, n = 450) and dual antiplatelet therapy (aspirin and clopidogrel; standard group, n = 450) for 6 months in patients with diabetes or long lesions receiving drug-eluting stents. We evaluated 2-year major adverse cardiac events (MACEs) including death, myocardial infarction (MI), and TLR. Nine-month TLRs and MACEs were significantly decreased in the triple versus standard group. At 2 years, the triple group sowed significantly decreased TLRs (4.2% vs 9.1%, hazard ratio 0.45, 95% confidence interval 0.26 to 0.78, p = 0.004) and MACEs (5.6% vs 10.4%, hazard ratio 0.52, 95% confidence interval 0.32 to 0.84, p = 0.008) compared to the standard group with no differences in death and MI. In subgroup analysis, triple antiplatelet therapy decrease of 2-year TLR was favorable in all subgroups, especially in patients with paclitaxel-eluting stents, diabetes mellitus, small vessels, long lesions, and left anterior descending coronary artery lesions. In conclusion, compared to the standard group, initial benefit in decreases of 9-month TLRs and MACEs in the triple group was sustained at 2 years with no differences in death or MI. Triple antiplatelet therapy decrease of 2-year TLR was favorable in all subgroups, especially in patients with high-risk profiles.
Authors:
Seung-Whan Lee; Kook-Jin Chun; Seong-Wook Park; Hyun-Sook Kim; Young-Hak Kim; Sung-Cheol Yun; Won-Jang Kim; Jong-Young Lee; Duk-Woo Park; Cheol Whan Lee; Myeong-Ki Hong; Kyoung-Suk Rhee; Jei Keon Chae; Jae-Ki Ko; Jae-Hyeong Park; Jae-Hwan Lee; Si Wan Choi; Jin-Ok Jeong; In-Whan Seong; Suh Jon; Yoon Haeng Cho; Nae-Hee Lee; June Hong Kim; Seung-Jung Park
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Publication Detail:
Type:  Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't     Date:  2009-12-03
Journal Detail:
Title:  The American journal of cardiology     Volume:  105     ISSN:  1879-1913     ISO Abbreviation:  Am. J. Cardiol.     Publication Date:  2010 Jan 
Date Detail:
Created Date:  2010-01-27     Completed Date:  2010-02-25     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0207277     Medline TA:  Am J Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  168-73     Citation Subset:  AIM; IM    
Copyright Information:
Copyright 2010 Elsevier Inc. All rights reserved.
Affiliation:
Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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MeSH Terms
Descriptor/Qualifier:
Aged
Angioplasty, Transluminal, Percutaneous Coronary
Aspirin / administration & dosage*
Coronary Restenosis / diagnosis,  epidemiology,  prevention & control*
Diabetes Complications / complications,  pathology,  therapy
Drug Therapy, Combination
Drug-Eluting Stents*
Female
Follow-Up Studies
Graft Occlusion, Vascular / diagnosis,  epidemiology,  prevention & control
Humans
Male
Middle Aged
Platelet Aggregation Inhibitors / administration & dosage*
Tetrazoles / administration & dosage*
Ticlopidine / administration & dosage,  analogs & derivatives*
Treatment Outcome
Chemical
Reg. No./Substance:
0/Platelet Aggregation Inhibitors; 0/Tetrazoles; 50-78-2/Aspirin; 55142-85-3/Ticlopidine; 73963-72-1/cilostazol; 90055-48-4/clopidogrel

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