Several clinical studies have reported the use of cilostazol in addition to aspirin and thienopyridine (triple antiplatelet therapy, TAPT) after percutaneous coronary intervention (PCI) decreases clinical events. However, the efficacy and safety of TAPT have not been fully evaluated in Japan. The prospectively collected data from 12824 Japanese patients received PCI as part of the j-Cypher Registry were analyzed. We selected 10356 patients who exclusively received implantation of sirolimus-eluting stents (SES), and compared the data from 10128 patients who received dual antiplatelet therapy (aspirin + thienopyridine, DAPT) with 228 patients who received TAPT at the time of discharge. Patients who received TAPT had more comorbidities, such as peripheral vascular disease, renal failure with hemodialysis or insulin dependent diabetes mellitus, and more patients received stenting for the left main trunk. The cardiovascular event rates at 3 years after PCI in the TAPT group were not significantly different from DAPT group, even after adjusted risks for cardiovascular events; all-cause death (7.8 vs. 6.7 %, log-rank p = 0.44, adjusted Hazard Ratio [HR] 0.88: 95 % confidence interval [CI] 0.52–1.38, p = 0.61), myocardial infarction (1.7 vs. 2.4 %, log-rank p = 0.49 and HR 0.71: 95 % CI 0.20–1.57, p = 0.40), target legion revascularization (12.7 vs. 9.9 %, log-rank p = 0.11 and HR 1.05: 95 % CI 0.71–1.50, p = 0.91) and stroke (3.9 vs. 3.2 %, log-rank p = 0.52 and HR 1.09: 95 % CI 0.52–2.00, p = 0.80). In conclusion, TAPT after SES implantation was associated with similar long-term clinical outcomes as DAPT in Japanese real-world clinical practice, although we did not evaluate the bleeding outcome.
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We thank the members of the cardiac catheterization laboratories of the participating centers and the clinical research coordinators. This study was supported by Cordis Cardiology Japan, a Johnson & Johnson company. The study sponsor was not involved in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the article for publication.
Conflict of interests
Dr Kimura serves as an advisory board member and member of the speakers’ bureau for Cordis Cardiology and has received honoraria from Cordis Cardiology. The remaining authors report no potential conflicts of interest.
On Behalf of the j-Cypher Registry Investigators.
This study was supported by Cordis Cardiology Japan, a Johnson & Johnson company.
A complete list of the investigators and committees involved in the j-Cypher registry has been published previously .
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Nakao, T., Kimura, T., Morimoto, T. et al. The long-term efficacy of cilostazol in addition to dual antiplatelet therapy after sirolimus-eluting stent implantation for Japanese patients: an analysis of the 3-year follow-up outcomes from the j-Cypher registry. Cardiovasc Interv and Ther 27, 161–167 (2012) doi:10.1007/s12928-012-0105-4
- Percutaneous coronary intervention
- Triple antiplatelet therapy