Background: In-stent restenosis has been associated with the occurrence of death, myocardial infarction and revascularization after percutaneous coronary intervention. It has an incidence of .8% even in the drug eluting stent era. The use of anti-platelets agents aspirin and c1opidogrel has partially addressed this problem. The addition of cilostazol has been attributed in further decreasing the incidence of in-stent restenosis. Studies involving the use of cilostazol have largely involved the use of bare-metal stents. At the moment, there is only one study on cilostazol involving drug-eluting stents which focused mainly on diabetics.
Methods: All patients above 19 years of age who had undergone elective percutaneous coronary intervention in the Philippine Heart Center and were given aspirin (300 mg once a day) and c1opidogrel (75 mg once a day) with or without cilostazol (100 mg twice a day) were included in the study. Patients were followed up for of 4.5 months. Patients were monitored for the occurrence of primary outcomes which included death, myocardial infarction and revascularization. Secondary outcome included the occurrence of bleeding, either major or minor.
Results: A total of 45 patients were included. In the dual anti-platelet group, the mean age was 63 years with predominance of males. In the triple anti-platelet group, the mean age was 59 years with predominance of males. Hypertension, diabetes mellitus, stroke and smoking were the most common risk factors without significant difference between the two groups (75% vs. 65%, p = 0.699, 50% 41 %, p= 0.704, 12% vs. 5%, p= 0.452, 50% vs. 49%, p= 1.0 respectively). Statins were the most commonly prescribed medication (62% vs. 65%, p= 1.0). Drug-eluting stent was used in majority of patients (100% vs. 97%, p= 1.0). The addition of cilostazol to standard therapy of aspirin and c1opidogrel did not show statistical significance in reducing death myocardial infarction and revascularization vs. that of aspirin and c1opidogrel alone. There was a trend of increased incidence of minor bleeding in the triple anti-platelet group but was not statistically significant (0% vs. 5%, p= 0.568).
Conclusion: The addition of cilostazol to standard therapy of aspirin and c1opidogrel did not show statistically significant reduction in death, myocardial infarction and revascularization compared with aspirin and clopidogrel alone with a trend towards increased risk of minor bleeding complications.