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

- Patients receiving additional cilostazol (TAT) have significantly reduced risk of major adverse cardiac events
- They also have reduced target lesion revascularization and target vessel revascularization
- TAT also reduces in-stent restenosis, in-segment restenosis and in-stent late loss
- TAT, however, significantly increases rash, gastrointestinal side-effects, headache and drug discontinuation.

ObjectiveTo 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.MethodsWe 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.ResultsSeven 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.ConclusionsCompared 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.