Addition of Cilostazol to Conventional Dual Antiplatelet Therapy Reduces the Risk of Cardiac Events and Restenosis After Drug-Eluting Stent Implantation: A Meta-Analysis

This meta-analysis was performed to compare the risk of cardiac events and restenosis between triple antiplatelet therapy (TAT, addition of cilostazol to aspirin and clopidogrel) and conventional dual antiplatelet therapy (DAT, aspirin and clopidogrel) in drug-eluting stents (DES) implantation patients. We performed PUBMED, MEDLINE, EMBASE, and Cochrane CENTRAL searches for randomized clinical trials of TAT versus DAT in patients after DES implantation. Five clinical trials were involved in the study. TAT was associated with a 36% reduction in major adverse cardiac events (MACE; odds ratio (OR)=0.64; 95% confidence interval (CI)=0.510.81, P<.01), a 40% reduction (OR=0.60, 95% CI=0.440.80; P<.01) in target vessel revascularization (TVR), a 44% reduction (OR=0.56, 95% CI=0.340.91; P=.02) in target lesion revascularization (TLR) and a 47%/44% reduction in in-segment/in-stent restenosis (P<.01) and lower in-segment/in-stent late loss (P<.01). As regards to the safety assessment, there was no significant difference about the risk of stent thrombosis and bleeding between TAT and DAT group, while the risk of gastrointestinal trouble was significantly higher in TAT group (OR=2.46, 95% CI=1.254.86; P<.01). Addition of cilostazol to DAT reduced the incidence of MACE, TVR, and TLR after DES implantation. TAT also reduced the risk of restenosis and late loss in patients after DES implantation.