Long-term clinical efficacy and safety of adding cilostazol to dual antiplatelet therapy after drug-eluting stent implantation in coronary arteries: A meta-analysis of randomized controlled trials

Abstract

Objective: To assess the long-term clinical efficacy and safety of adding cilostazol (TAT) to conventional dual antiplatelet therapy (DAT) for patients undergoing drug-eluting stent (DES) implantation in coronary arteries.

Methods: We performed PUBMED, MEDLINE, EMBASE, and Cochrane CENTRAL searches for randomized clinical trials of TAT versus DAT in patients after DES implantation with criteria to include trials with a follow-up of more than 6 months.

Results: Seven RCTs with a total of 3487 patients were included in this review. The meta-analysis showed that TAT was associated with a significant reduction in major adverse cardiac events (MACEs) (relative risk (RR)=0.66; 95% CI=0.50-0.88), target lesion revascularization (TLR) (RR=0.61, 95% CI=0.43-0.84), target vessel revascularization (TVR) (RR=0.53, 95% CI=0.37-0.75), in-stent restenosis (RR=0.64, 95% CI=0.44-0.85), in-segment restenosis (RR=0.58, 95% CI=0.43-0.79, P<.01), in-stent late loss (LL) (standardized mean difference (SMD)=-0.21, 95% CI=0.32-0.17), and in-segment LL (SMD=-0.27, 95% CI=-0.38-0.16). TAT also did not appear to significantly alter any of the other meta-analysis secondary efficacy outcomes and had similar rates of bleeding, but TAT had significantly higher rates of rash, gastrointestinal side-effects, headache and drug discontinuation.

Conclusions: Compared with standard DAT, the long-term use of TAT in patients after DES implantation gave more benefits in reducing the incidence of MACEs, TLR, TVR, in-stent and in-segment LL and restenosis without increasing bleeding but was associated with an increase in minor adverse events.

Keywords: Cilostazol; Drug-eluting stent; Dual antiplatelet therapy; Triple antiplatelet therapy.