Cilostazol for Chinese Patients with Aspirin Intolerance after Coronary Drug-Eluting Stent ImplantationFunding This study was supported by National Natural Science Foundation of China (Grant No: 81970295, 81870267, 81570314, and 81670318), Grant of Shanghai Municipal Commission of Health and Family Planning (Grant No: 2017YQ057), Grant of Shanghai Science and Technology Committee (Grant No: 17411962300), the National Program on Key Basic Research Project of China (973 Program, Grant No: 2014CBA02003), Program for Outstanding Medical Academic Leader (Grant No: 2015-Weijiwei-24), Grant of Zhongshan Hospital Affiliated to Fudan University (Grant No: 2015ZSYXGG07 and 2017ZSYQ08), VG Funding of Clinical Trials (2017-CCA-VG-036), and Merck Funding (Xinxin-merck-fund-051).
18 December 2019
20 February 2020
05 May 2020 (online)
Background Cilostazol-based dual antiplatelet therapy (DAPT) is widely used in patients with aspirin intolerance after coronary drug-eluting stent (DES) implantation in China. However, this empirical strategy is not recommended or even mentioned in Chinese or international guidelines due to a lack of evidence from large-scale studies. We aimed to explore the efficacy and safety of cilostazol-based DAPT in this special population.
Methods In this cohort study, patients were grouped according to the DAPT strategy that they received after coronary DES implantation. The primary efficacy endpoint was major adverse cardiovascular and cerebrovascular events (MACCEs). Angiographic follow-up and major bleeding events were also recorded.
Results A total of 918 patients receiving cilostazol-based DAPT due to aspirin intolerance were enrolled, matched with 918 patients receiving aspirin-based DAPT. After 15-month prospective follow-up, the cilostazol group had lower risk of MACCE (5.1% vs. 7.6%, propensity score adjusted hazard ratio = 0.671 [95% confidence interval 0.462–0.974], p = 0.036) compared with the aspirin group. Lower rate of coronary lesion progression was also found through follow-up angiography in the cilostazol group (17.4% vs. 23.6%, p = 0.022), especially in nontarget lesions (12.1% vs. 17.6%, p = 0.019). The two groups had the same risk of major bleeding events (0.8% vs. 0.4%, p = 0.364).
Conclusion In the current study, cilostazol is a good substitute for aspirin in patients who have aspirin intolerance but need DAPT after coronary DES implantation in China. However, large-scale randomized controlled trials were still required to further confirm its efficacy and safety.
* Chunfeng Dai and Zhangwei Chen contributed equally to this article.
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