Cilostazol improves long-term patency after percutaneous transluminal angioplasty in hemodialysis patients with peripheral artery disease

Abstract

Background and objectives: Peripheral artery disease (PAD) is common in patients on hemodialysis (HD). Recently, cilostazol has been reported to reduce target lesion revascularization (TLR) after percutaneous transluminal angioplasty (PTA) for PAD in the general population. This study aimed to clarify the effects of cilostazol administration on long-term patency after PTA in HD patients.

Design, setting, participants, & measurements: Three-hundred seventy-two consecutive lesions in 193 HD patients successfully undergoing PTA were enrolled in the study and divided into two groups: patients receiving 100 mg cilostazol twice daily in conjunction with standard therapy (130 lesions in 71 patients) and those not administered cilostazol (242 lesions in 122 patients). Effects of cilostazol on preventing restenosis after PTA in these patients were investigated.

Results: Kaplan-Meier analysis demonstrated the 5-yr patency rate was significantly higher in the cilostazol group than in the control group [52.4 versus 32.9%, hazard ratio (HR) 0.55; 95% confidence interval (CI) 0.39 to 0.77, P = 0.0005]. Cox multivariate analysis revealed that administration of cilostazol was an independent predictor of preventing restenosis (HR 0.56, 95% CI 0.36 to 0.87, P = 0.010). In 102 lesions matched after propensity score analysis, cilostazol had a beneficial effect on preventing restenosis (58.4 versus 34.7%, HR 0.47, 95% CI 0.30 to 0.75, P = 0.0017) and was an independent predictor of preventing restenosis (HR 0.50; 95% CI 0.26 to 0.87, P = 0.014) after multivariate Cox analysis.

Conclusions: Cilostazol administration improves long-term patency after PTA in HD patients with PAD.

Figure 1.

Kaplan-Meier curves for the primary endpoint: The 5-yr event-free rate from restenosis for 5 yr was 52.4% in the cilostazol group and 32.9% in the control group [hazard ratio (HR) 0.55, 95% confidence interval (CI) 0.39 to 0.77, P = 0.0005].

Figure 2.

Kaplan-Meier curves for the primary endpoint in propensity-matched patient: The event-free rate from the primary endpoint for 5 yr was 58.4% in the cilostazol group and 34.7% in the control group (HR 0.47, 95% CI 0.30 to 0.75, P = 0.0017).