Document Detail

A randomized, double-blind, multicenter comparison study of triple antiplatelet therapy with dual antiplatelet therapy to reduce restenosis after drug-eluting stent implantation in long coronary lesions: results from the DECLARE-LONG II (Drug-Eluting Stenting Followed by Cilostazol Treatment Reduces Late Restenosis in Patients with Long Coronary Lesions) trial.
MedLine Citation:
PMID:  21392640     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: The purpose of this study was to determine whether cilostazol reduces intimal hyperplasia in patients undergoing long zotarolimus-eluting stent implantation (stent length: ≥ 30 mm) for native long coronary lesions (length: ≥ 25 mm).
BACKGROUND: Restenosis after drug-eluting stent implantation remains a significant clinical problem in long coronary lesions.
METHODS: Patients (n = 499) were assigned randomly to triple (aspirin, clopidogrel, and cilostazol, triple group: n = 250) or dual antiplatelet therapy (aspirin and clopidogrel and placebo, dual group: n = 249) for 8 months after long zotarolimus-eluting stent implantation. The primary end point was in-stent late loss at the 8-month angiography according to the intention-to-treat principle.
RESULTS: The 2 groups had similar baseline characteristics. The in-stent (0.56 ± 0.55 mm vs. 0.68 ± 0.59 mm, p = 0.045) and in-segment (0.32 ± 0.54 mm vs. 0.47 ± 0.54 mm, p = 0.006) late loss were significantly lower in the triple versus dual group, as were 8-month in-stent restenosis (10.8% vs. 19.1%, p = 0.016), in-segment restenosis (12.2% vs. 20.0%, p = 0.028), and 12-month ischemic-driven target lesion revascularization (5.2% vs. 10.0%, p = 0.042) rates. At 12 months, major adverse cardiac events including death, myocardial infarction, and ischemic-driven target lesion revascularization tended to be lower in the triple group than the dual group (7.2% vs. 12.0%, p = 0.07). Percent intimal hyperplasia volume by volumetric intravascular ultrasound analysis was reduced from 27.1 ± 13.2% for the dual group to 22.1 ± 9.9% for the triple group (p = 0.017).
CONCLUSIONS: Patients receiving triple antiplatelet therapy after long zotarolimus-eluting stent implantation had decreased extent of late luminal loss, percent intimal hyperplasia volume, and angiographic restenosis, resulting in a reduced risk of 12-month target lesion revascularization compared with patients receiving dual antiplatelet therapy. (Triple Versus Dual Antiplatelet Therapy after ABT578-Eluting Stent; NCT00589927).
Seung-Whan Lee; Seong-Wook Park; Young-Hak Kim; Sung-Cheol Yun; Duk-Woo Park; Cheol Whan Lee; Soo-Jin Kang; Seung-Jung Park; Jae-Hwan Lee; Si Wan Choi; In-Whan Seong; Nae-Hee Lee; Yoon Haeng Cho; Won-Yong Shin; Seung-Jin Lee; Se-Whan Lee; Min-Su Hyon; Duk-Won Bang; Young-Jin Choi; Hyun-Sook Kim; Bong-Ki Lee; Keun Lee; Hoon-Ki Park; Chang-Bum Park; Sang-Gon Lee; Min-Kyu Kim; Kyoung-Ha Park; Woo-Jung Park;
Publication Detail:
Type:  Comparative Study; Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  57     ISSN:  1558-3597     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  2011 Mar 
Date Detail:
Created Date:  2011-03-11     Completed Date:  2011-05-16     Revised Date:  2013-05-30    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1264-70     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2011 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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MeSH Terms
Aspirin / administration & dosage*
Coronary Artery Disease / radiography,  therapy
Coronary Restenosis / etiology,  prevention & control*,  radiography
Double-Blind Method
Drug Therapy, Combination
Drug-Eluting Stents / adverse effects*
Follow-Up Studies
Middle Aged
Platelet Aggregation Inhibitors / administration & dosage*
Prospective Studies
Tetrazoles / administration & dosage*
Ticlopidine / administration & dosage,  analogs & derivatives*
Treatment Outcome
Reg. No./Substance:
0/Platelet Aggregation Inhibitors; 0/Tetrazoles; 50-78-2/Aspirin; 55142-85-3/Ticlopidine; A74586SNO7/clopidogrel; N7Z035406B/cilostazol
Comment In:
Nat Rev Cardiol. 2011 Jun;8(6):304   [PMID:  21451468 ]

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