NEW YORK (Reuters Health) – Adding cilostazol to dual antiplatelet therapy cuts revascularization rates after percutaneous coronary intervention (PCI), but has no impact on heart attacks or deaths, according to a new meta-analysis.
“We found that the addition of cilostazol significantly reduced target lesion revascularization (TLR) and target vessel revascularization (TVR) 6 to 12 months after stent implantation,” senior author Dr. Avi Shimony from McGill University in Montreal, Canada, told Reuters Health by email.
“Adjunctive cilostazol was not associated with an increase in adverse events,” he said. The findings were published online February 28 in the American Journal of Cardiology.
Dr. Shimony and colleagues conducted a systematic review and meta-analysis of 12 randomized controlled trials involving a total of 5,655 patients to evaluate the effect on clinical outcomes and safety of adding cilostazol to dual antiplatelet therapy (DAT, aspirin, and clopidogrel) after PCI.
“Our sample size (is) more than twofold greater than 2 previous meta-analyses and therefore we believe that our study provides a strong message,” Shimony said.
Addition of cilostazol did not significantly reduce TLR in the first month after PCI. In contrast, the addition of cilostazol to DAT cut TLR by 43% in mid-term follow-up (6 to 12 months after PCI, based on six trials) and by 54% reduction in TLR beyond 12 months after PCI (based on one trial).
Results for TVR were similar: no significant reduction with cilostazol in the first month, a 38% reduction in mid-term follow-up, and a trend toward a 34% reduction beyond one year.
Adding cilostazol to DAT had no effect on myocardial infarction, mortality, or major bleeding rates.
“Hopefully, our study would provide a necessary sway for conducting large clinical trials in diverse populations,” Dr. Shimony concluded. “In addition, the fact that triple therapy might be more cost-effective in terms of health-care utilization and restenosis prevention (rehospitalization, outpatient tests, TLR procedures) is by itself an important issue in times of economic restraints.”
Am J Cardiol 2012.