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DECREASE-PCI: Triple antiplatelet therapy reduces TVR after DES implantation
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Patients with CAD who underwent an implantation of a second-generation drug-eluting stent and treated with triple antiplatelet therapy with cilostazol had a reduced risk for target vessel revascularization compared with those treated with aspirin and clopidogrel only.
Cheol Hyun Lee, MD, of the department of cardiology at Asan Medical Center at University of Ulsan College of Medicine in Seoul, Korea, and colleagues analyzed data from 404 patients (mean age, 62 years; 71% men) with CAD from nine cardiac centers in Korea. Eligible patients had ACS or stable angina and had at least one coronary lesion that required DES implantation.
After implantation, patients were assigned to triple antiplatelet therapy with clopidogrel, aspirin and cilostazol (n = 202) or dual antiplatelet therapy with clopidogrel, aspirin and placebo (n = 202).
At least 24 hours before the procedure and after, both groups received clopidogrel and aspirin. Patients then received a loading dose of cilostazol 200 mg or placebo up to 1 hour after the procedure, then 100 mg cilostazol or placebo twice per day for 12 months.
The primary endpoint was the occurrence of MACCE, defined as a composite of MI, all-cause death, ischemic-driven TVR or ischemic stroke 1 year after PCI. Secondary endpoints included MACE, defined as ischemia-driven TVR, all-cause death and MI.
Follow-up was conducted at 1 month, 6 months and 1 year, when ECGs, physical examination, angina recurrence, clinical events, patient compliance and clinical and laboratory assessments were performed and reviewed.
At 1 year, the primary endpoint occurred in 3.6% of patients assigned triple antiplatelet therapy and 9.4% of those assigned DAPT (HR = 0.396; 95% CI, 0.166-0.949). The number needed to treat to prevent the primary endpoint was 18.4.
The occurrence of a composite of MI, all-cause death or ischemic stroke did not significantly differ between both groups (HR = 0.583; 95% CI, 0.229-1.481). TIMI minor and major bleeding also did not statistically differ in both groups.
The triple antiplatelet therapy group had significantly fewer instances of TVR compared with the DAPT group (HR = 0.118; 95% CI, 0.015-0.93).
“Our study showed additional clinical benefits of triple therapy with cilostazol without increasing serious adverse events,” Lee and colleagues wrote. “Therefore, additional cilostazol therapy could play an additional role in high-risk patients with stable coronary artery disease.” – by Darlene Dobkowski
Disclosures: The DECREASE-PCI trial was supported by Korea Otsuka Pharmaceutical Co., Ltd. The authors report no relevant financial disclosures.
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