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AS-254: Impact of Low-Dose Aspirin on Acetylcholine-Induced Coronary Artery Spasm and 12 Month Clinical Outcome
Wednesday, April 28 - Friday, April 30, 2010 (E-Poster Abstract Zone)
AS-252 The Impact of Non-Cytochrome 3A4 Metabolized Statin in Patients with High Post-Clopidogrel Platelet Reactivity: The Results of the ACCEL-SWITCH Study. Young-Hoon Jeong, In-Suk Kim, Yongwhi Park, Seok-Jae Hwang, Choong Hwan Kwak, Jin-Yong Hwang. Gyeongsang National University Hospital, Jinju, Republic of Korea. Background: Clopidogrel is an inactive prodrug that is converted into the active metabolites by the cytochrome P-450 (CYP) system. The impact of coadministration of statin and clopidogrel on platelet inhibition is controversial, which may result from assessment during early period statin use, differences in assays used, and the selection of high posttreatment platelet reactivity (HPPR) and normal responders to clopidogrel. During chronic phase of coadministration of statin and clopidogrel, the influence of CYP3A4 vs non-CYP3A4 metabolized statin on platelet inhibition has not been evaluated. Methods: We conducted this study to evaluate enhanced platelet inhibition after change with non-CYP3A4 metabolized statin (rosuvastatin or pravastatin) in HPPR patients receiving coadministration of CYP3A4 metabolized statin (atorvastatin) and clopidogrel. Platelet reactivity was assessed with conventional aggregometry and the VerifyNow P2Y12 assay. We enrolled 40 patients with HPPR from cohorts receiving clopidogrel 75-mg/day and atorvastatin 10-mg/day at least 6 months after percutaneous coronary intervention. They were randomly switched to rosuvastatin 10-mg/day (n ⫽ 20) or pravastatin 20-mg/day (n ⫽ 20). At the 30-day follow-up visit, platelet reactivity was reassessed. Results: Maximal platelet reactivity with 5 and 20 mol/L stimuli was decreased after switch (52.7 ⫾ 11% to 46.2 ⫾ 16%, p ⫽ 0.004, 66.9 ⫾ 8% to 60.5 ⫾ 14%, p ⫽ 0.001, respectively). Likewise, 5 and 20 mol/L-late platelet reactivity also reduced after switch (41.7 ⫾ 15% to 34.9 ⫾ 19%, p ⫽ 0.004, 58.7 ⫾ 13% to 50.6 ⫾ 20%, p ⫽ 0.002, respectively). There was significant reduction of P2Y12 reaction unit before and after switch (294.8 ⫾ 64 vs 244.5 ⫾ 80, p ⬍0.001). Rate of HPPR after switch was reduced (100% to 77.5%, p ⫽ 0.001). Dividing patients into rosuvastatin vs pravastatin groups, there were no differences in absolute reductions in terms of all platelet measures. Conclusion: Switch administration with non-CYP3A4 metabolized statin (rosuvastatin or pravastatin) in HPPR patients receiving atorvastatin can enhance platelet inhibition and reduce the rate of HPPR. It needs to be evaluated whether the change with non-CYP3A4 metabolized statin in HPPR patients could be translated into improved clinical outcomes.
AS-253 The Effect of Cocoa on Impaired Flow-Mediated Dilation in Working Night Shifts. Sun Ho Hwang1, Kyung Hee Hong1, Chan Young Park1, Hyung Min Noh1, Myong Joo Hong1, Seung Ju Kim1, Jong Bum Kim1, Eun Kyung Jo1, Hyun Hee Park1, Weon Kim2, Wan Kim1. 1Gwangju Veterans Hospital, Gwangju, Republic of Korea; 2Kyung Hee University Medical Center, Seoul, Republic of Korea. Background: Our previous study suggests that 3 sequential night shifts deteriorated endothelial function through decreased production of nitric oxide (NO). Flavanols have been suggested to mediate the favorable effects on cardiovascular health. The aim of this study was to examine the effect of flavonol-rich cocoa on endothelial function and oxidative stress in healthy medical personnel with 3 sequential night shifts. Methods: This prospective, open-label, case– control study was designed for 40 young healthy nurses divided into 2 groups. The cocoa
group (n ⫽ 20, 28.5 ⫾ 4.5 years) received dark chocolate (48 g/day; containing 813 mg polyphenol) for 3 days, and the control group (n ⫽ 20, 27.4 ⫾ 3.2 years) did not receive chocolate. We examined flowmediated dilatation (FMD), high-sensitivity C-reactive protein (hsCRP), oxidative markers (NO and malondialdehyde) before and after three-night shift. Results: Baseline characteristics were not different between the 2 groups. FMD was significantly decreased after continuous 3 night shifts in both groups (p ⬍0.001). FMD change (i.e., deterioration of vascular endothelial function) was lower in the cocoa group than the control group (5.83% vs 3.14%, p ⫽ 0.041). Result of inflammatory marker (hsCRP), oxidative markers (NO and malondialdehyde) will be presented. Conclusion: This study indicated that 3 night shifts aggravated endothelial function. However, consumption of small amounts of polyphenol-rich dark chocolate may improve endothelial function.
AS-254 Impact of Low-Dose Aspirin on Acetylcholine-Induced Coronary Artery Spasm and 12 Month Clinical Outcome. Ji Young Park, Seung-Woon Rha, Kanhaiya L. Poddar, Sureshkumar Ramasamy, Lin Wang, Byoung Geol Choi, Ji Bak Kim, Seung Yong Shin, Un-Jung Choi, Cheol Ung Choi, Hong Euy Lim, Jin Won Kim, Eung Ju Kim, Chang Gyu Park, Hong Seog Seo, Dong Joo Oh. Korea University Guro Hospital, Seoul, Republic of Korea. Background: Aspirin is a nonselective cyclooxygenase inhibitor, and high-dose aspirin can aggravate coronary artery spasm (CAS). However, whether low-dose aspirin can similarly affect coronary spasm is largely unknown. Therefore, we evaluated the impact of low-dose aspirin on acetylcholine (Ach)-induced coronary artery spasm (CAS) and 12-month clinical outcome. Methods: This study enrolled 1068 consecutive patients without significant CAD who underwent the Ach provocation test between March 2004 and April 2009. The Ach provocation test results and its associated parameters were compared between 2 groups (aspirin group, n ⫽ 195; no aspirin group, n ⫽ 873). Ach was injected in incremental doses of 20 mg (A1), 50 mg (A2), and 100 mg (A3) into the left coronary artery. Significant CAS was defined as transient ⬎70% luminal narrowing with or without ischemic ST-T Change or chest pain. Results: The baseline clinical characteristics showed that the classic risk factors including diabetes mellitus, hypertension, and hyperlipidemia were more common in the aspirin group. After Ach injection, the rate of positive provocation test result were more common in the aspirin group, but associated angiographic and clinical parameters were not different between the 2 groups. Multivariate logistic analysis showed that aspirin was an independent risk factor for Ach-induced CAS (adjusted odds ratio 1.28, 95% confidence interval 1.01–1.62, p ⫽ 0.037). Twelve-month clinical outcomes including death and myocardial infarction (MI) were similar between groups. However, repeat Ach provocation test due to recurrent or refractory chest pain was more common in the aspirin group (2.8% vs 0.2%, p ⬍0.01). Conclusion: In our study, low-dose aspirin was an independent risk factor of Ach-induced significant CAS, and repeat Ach provocation test was performed more frequently because of recurrent chest pain. However, 12-month clinical outcomes including death and MI were not different between the 2 groups, with the exception of PCI on de novo lesions, which was higher in the aspirin group. If a patient on low-dose aspirin is proven to have significant CAS, special caution should be exercised (Table).
The American Journal of Cardiology姞 APRIL 28 –30 2010 ANGIOPLASTY SUMMIT ABSTRACTS/E-Poster107B
EP O S T E R A B S T R A C T S
Wednesday, April 28 - Friday, April 30, 2010 (E-Poster Abstract Zone) Results: Of the 5864 patients, 1187 (20%) were prescribed oral nicorandil at discharge. By 1-year follow-up, incident events were 195 deaths, 46 MIs, 440 repeat PCIs, and 18 CABGs. There were no significant differences in age, sex, comorbidities, blood pressure, Killip class, creatinine clearance, left ventricular ejection fraction, N-terminal pro-B-type natriuretic peptide, and angiographic findings between the 2 groups. High-sensitivity C-reactive protein level was lower in the nicorandil group. Postdischarge oral nicorandil group did not have lower incidence rates of death, MI, repeat PCI, or CABG during 1-year clinical follow-up. In a multivariable regression adjustment with background covariates and the propensity score, postdischarge oral nicorandil therapy was not an independent predictor of 12-month mortality. Conclusion: Postdischarge oral nicorandil therapy has no beneficial effect on long-term clinical outcomes after PCI in AMI patients.
AS-256 Triple versus Dual Antiplatelet Therapy in Chronic Stable Angina Patients with Diabetes Undergoing Elective Percutaneous Coronary Intervention with Drug-Eluting Stents. Kanhaiya L. Poddar, Seung-Woon Rha, Ji Young Park, Sureshkumar Ramasamy, Lin Wang, Byoung Geol Choi, Ji Bak Kim, Seung Yong Shin, Cheol Ung Choi, Hong Euy Lim, Jin Won Kim, Eung Ju Kim, Chang Gyu Park, Hong Seog Seo, Dong Joo Oh. Korea University Guro Hospital, Seoul, Korea (Republic of).
AS-255
EP O S T E R A B S T R A C T S
The Clinical Effect of Oral Nicorandil on Long-Term Clinical Outcomes in Acute Myocardial Infarction. Kyung Hoon Cho1, Myung Ho Jeong1, Young Keun Ahn1, Jong Hyun Kim2, Shung Chull Chae3, Young Jo Kim4, Seung Ho Hur5, In Whan Seong6, Taek Jong Hong7, Dong Hoon Choi8, Myeong Chan Cho9, Chong Jin Kim10, Ki Bae Seung11, Wook Sung Chung11, Yang Soo Jang8, Seung-Woon Rha12, Jang Ho Bae13, Jeong Gwan Cho1, Seung Jung Park14, KAMIR Investigators15. 1Chonnam National University Hospital, Gwangju, Republic of Korea; 2Busan Hanseo Hospital, Busan, Republic of Korea; 3Kyungpook National University Hospital, Daegu, Republic of Korea; 4Yeungnam University Hospital, Daegu, Republic of Korea; 5Keimyung University Hospital Dongsan Medical Center, Daegu, Republic of Korea; 6Chungnam National University, Daejon, Republic of Korea; 7Busan National University Hospital, Busan, Republic of Korea; 8Yonsei University Severans Hospital, Seoul, Republic of Korea; 9Chungbuk National University Hospital, Cheongju, Republic of Korea; 10Kyunghee University Hospital, Seoul, Republic of Korea; 11The Catholic University of Korea, Seoul St. Mary’s Hospital, Seoul, Republic of Korea; 12Korea University Guro Hospital, Seoul, Republic of Korea; 13Konyang University Hospital, Daejon, Republic of Korea; 14Asan Medical Center, Seoul, Republic of Korea; 15Other KAMIR, investigators, Seoul, Republic of Korea. Background: This study examined the effect of oral nicorandil on long-term clinical outcomes after percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI). Methods: As part of the Korean Acute Myocardial Infarction Registry (KAMIR), we enrolled 5864 eligible patients with discharge medication undergoing a 1-year follow-up after PCI for AMI from October 2005 and January 2008. The patients were divided on the basis of prescription for oral nicorandil on discharge. The occurrences of death, MI, repeat PCI, and coronary artery bypass graft surgery (CABG) were collected over 1-year follow-up.
Background: Adjunctive cilostazol to dual antiplatelet therapy (triple antiplatelet therapy) is known to reduce restenosis and is associated with favorable clinical outcomes in diabetes. However, there is limited data related to the use of triple antiplatelet therapy in chronic stable angina patients with diabetes in real-world clinical practice. Methods: The study population consisted of 301 consecutive patients (excluding acute myocardial infarction [AMI] and those without diabetes) who underwent elective PCI with drug-eluting stents (DES) from April 2006 to February 2009. Usage of adjunctive cilostazol was at the physician’s discretion. Cilostazol was administered by 200-mg post-loading and then 100 mg twice daily for at least 1 month. Clinical and angiographic outcomes at 6 months in the triple-therapy group were compared with those of the dual antiplatelet group. Results: Of 301 patients, 111 (36.88%) received adjunctive cilostazol. Patients in the triple-therapy group had worse angiographic characteristics, including more left main, diffuse long, ostial lesions and calcified lesions, although this was not statistically significant. Multivariate analysis revealed that patients in the triple-therapy group had significantly fewer target vessel revascularizations and target lesion revascularizations. Angiographic outcomes were similar between the 2 groups. Although it was not statistically significant, there were 2 stent thromboses in the triple-therapy group, and no such event was seen in dual-therapy group (Table).
Conclusion: Diabetic patients presenting with chronic stable angina receiving cilostazol as adjunctive therapy along with dual anti-
108BThe American Journal of Cardiology姞 APRIL 28 –30 2010 ANGIOPLASTY SUMMIT ABSTRACTS/E-Poster
AS-252 The Impact of Non-Cytochrome 3A4 Metabolized Statin in Patients with High Post-Clopidogrel Platelet Reactivity: The Results of the ACCEL-SWITCH Study. Young-Hoon Jeong, In-Suk Kim, Yongwhi Park, Seok-Jae Hwang, Choong Hwan Kwak, Jin-Yong Hwang. Gyeongsang National University Hospital, Jinju, Republic of Korea. Background: Clopidogrel is an inactive prodrug that is converted into the active metabolites by the cytochrome P-450 (CYP) system. The impact of coadministration of statin and clopidogrel on platelet inhibition is controversial, which may result from assessment during early period statin use, differences in assays used, and the selection of high posttreatment platelet reactivity (HPPR) and normal responders to clopidogrel. During chronic phase of coadministration of statin and clopidogrel, the influence of CYP3A4 vs non-CYP3A4 metabolized statin on platelet inhibition has not been evaluated. Methods: We conducted this study to evaluate enhanced platelet inhibition after change with non-CYP3A4 metabolized statin (rosuvastatin or pravastatin) in HPPR patients receiving coadministration of CYP3A4 metabolized statin (atorvastatin) and clopidogrel. Platelet reactivity was assessed with conventional aggregometry and the VerifyNow P2Y12 assay. We enrolled 40 patients with HPPR from cohorts receiving clopidogrel 75-mg/day and atorvastatin 10-mg/day at least 6 months after percutaneous coronary intervention. They were randomly switched to rosuvastatin 10-mg/day (n ⫽ 20) or pravastatin 20-mg/day (n ⫽ 20). At the 30-day follow-up visit, platelet reactivity was reassessed. Results: Maximal platelet reactivity with 5 and 20 mol/L stimuli was decreased after switch (52.7 ⫾ 11% to 46.2 ⫾ 16%, p ⫽ 0.004, 66.9 ⫾ 8% to 60.5 ⫾ 14%, p ⫽ 0.001, respectively). Likewise, 5 and 20 mol/L-late platelet reactivity also reduced after switch (41.7 ⫾ 15% to 34.9 ⫾ 19%, p ⫽ 0.004, 58.7 ⫾ 13% to 50.6 ⫾ 20%, p ⫽ 0.002, respectively). There was significant reduction of P2Y12 reaction unit before and after switch (294.8 ⫾ 64 vs 244.5 ⫾ 80, p ⬍0.001). Rate of HPPR after switch was reduced (100% to 77.5%, p ⫽ 0.001). Dividing patients into rosuvastatin vs pravastatin groups, there were no differences in absolute reductions in terms of all platelet measures. Conclusion: Switch administration with non-CYP3A4 metabolized statin (rosuvastatin or pravastatin) in HPPR patients receiving atorvastatin can enhance platelet inhibition and reduce the rate of HPPR. It needs to be evaluated whether the change with non-CYP3A4 metabolized statin in HPPR patients could be translated into improved clinical outcomes.
AS-253 The Effect of Cocoa on Impaired Flow-Mediated Dilation in Working Night Shifts. Sun Ho Hwang1, Kyung Hee Hong1, Chan Young Park1, Hyung Min Noh1, Myong Joo Hong1, Seung Ju Kim1, Jong Bum Kim1, Eun Kyung Jo1, Hyun Hee Park1, Weon Kim2, Wan Kim1. 1Gwangju Veterans Hospital, Gwangju, Republic of Korea; 2Kyung Hee University Medical Center, Seoul, Republic of Korea. Background: Our previous study suggests that 3 sequential night shifts deteriorated endothelial function through decreased production of nitric oxide (NO). Flavanols have been suggested to mediate the favorable effects on cardiovascular health. The aim of this study was to examine the effect of flavonol-rich cocoa on endothelial function and oxidative stress in healthy medical personnel with 3 sequential night shifts. Methods: This prospective, open-label, case– control study was designed for 40 young healthy nurses divided into 2 groups. The cocoa
group (n ⫽ 20, 28.5 ⫾ 4.5 years) received dark chocolate (48 g/day; containing 813 mg polyphenol) for 3 days, and the control group (n ⫽ 20, 27.4 ⫾ 3.2 years) did not receive chocolate. We examined flowmediated dilatation (FMD), high-sensitivity C-reactive protein (hsCRP), oxidative markers (NO and malondialdehyde) before and after three-night shift. Results: Baseline characteristics were not different between the 2 groups. FMD was significantly decreased after continuous 3 night shifts in both groups (p ⬍0.001). FMD change (i.e., deterioration of vascular endothelial function) was lower in the cocoa group than the control group (5.83% vs 3.14%, p ⫽ 0.041). Result of inflammatory marker (hsCRP), oxidative markers (NO and malondialdehyde) will be presented. Conclusion: This study indicated that 3 night shifts aggravated endothelial function. However, consumption of small amounts of polyphenol-rich dark chocolate may improve endothelial function.
AS-254 Impact of Low-Dose Aspirin on Acetylcholine-Induced Coronary Artery Spasm and 12 Month Clinical Outcome. Ji Young Park, Seung-Woon Rha, Kanhaiya L. Poddar, Sureshkumar Ramasamy, Lin Wang, Byoung Geol Choi, Ji Bak Kim, Seung Yong Shin, Un-Jung Choi, Cheol Ung Choi, Hong Euy Lim, Jin Won Kim, Eung Ju Kim, Chang Gyu Park, Hong Seog Seo, Dong Joo Oh. Korea University Guro Hospital, Seoul, Republic of Korea. Background: Aspirin is a nonselective cyclooxygenase inhibitor, and high-dose aspirin can aggravate coronary artery spasm (CAS). However, whether low-dose aspirin can similarly affect coronary spasm is largely unknown. Therefore, we evaluated the impact of low-dose aspirin on acetylcholine (Ach)-induced coronary artery spasm (CAS) and 12-month clinical outcome. Methods: This study enrolled 1068 consecutive patients without significant CAD who underwent the Ach provocation test between March 2004 and April 2009. The Ach provocation test results and its associated parameters were compared between 2 groups (aspirin group, n ⫽ 195; no aspirin group, n ⫽ 873). Ach was injected in incremental doses of 20 mg (A1), 50 mg (A2), and 100 mg (A3) into the left coronary artery. Significant CAS was defined as transient ⬎70% luminal narrowing with or without ischemic ST-T Change or chest pain. Results: The baseline clinical characteristics showed that the classic risk factors including diabetes mellitus, hypertension, and hyperlipidemia were more common in the aspirin group. After Ach injection, the rate of positive provocation test result were more common in the aspirin group, but associated angiographic and clinical parameters were not different between the 2 groups. Multivariate logistic analysis showed that aspirin was an independent risk factor for Ach-induced CAS (adjusted odds ratio 1.28, 95% confidence interval 1.01–1.62, p ⫽ 0.037). Twelve-month clinical outcomes including death and myocardial infarction (MI) were similar between groups. However, repeat Ach provocation test due to recurrent or refractory chest pain was more common in the aspirin group (2.8% vs 0.2%, p ⬍0.01). Conclusion: In our study, low-dose aspirin was an independent risk factor of Ach-induced significant CAS, and repeat Ach provocation test was performed more frequently because of recurrent chest pain. However, 12-month clinical outcomes including death and MI were not different between the 2 groups, with the exception of PCI on de novo lesions, which was higher in the aspirin group. If a patient on low-dose aspirin is proven to have significant CAS, special caution should be exercised (Table).
The American Journal of Cardiology姞 APRIL 28 –30 2010 ANGIOPLASTY SUMMIT ABSTRACTS/E-Poster107B
EP O S T E R A B S T R A C T S
Wednesday, April 28 - Friday, April 30, 2010 (E-Poster Abstract Zone) Results: Of the 5864 patients, 1187 (20%) were prescribed oral nicorandil at discharge. By 1-year follow-up, incident events were 195 deaths, 46 MIs, 440 repeat PCIs, and 18 CABGs. There were no significant differences in age, sex, comorbidities, blood pressure, Killip class, creatinine clearance, left ventricular ejection fraction, N-terminal pro-B-type natriuretic peptide, and angiographic findings between the 2 groups. High-sensitivity C-reactive protein level was lower in the nicorandil group. Postdischarge oral nicorandil group did not have lower incidence rates of death, MI, repeat PCI, or CABG during 1-year clinical follow-up. In a multivariable regression adjustment with background covariates and the propensity score, postdischarge oral nicorandil therapy was not an independent predictor of 12-month mortality. Conclusion: Postdischarge oral nicorandil therapy has no beneficial effect on long-term clinical outcomes after PCI in AMI patients.
AS-256 Triple versus Dual Antiplatelet Therapy in Chronic Stable Angina Patients with Diabetes Undergoing Elective Percutaneous Coronary Intervention with Drug-Eluting Stents. Kanhaiya L. Poddar, Seung-Woon Rha, Ji Young Park, Sureshkumar Ramasamy, Lin Wang, Byoung Geol Choi, Ji Bak Kim, Seung Yong Shin, Cheol Ung Choi, Hong Euy Lim, Jin Won Kim, Eung Ju Kim, Chang Gyu Park, Hong Seog Seo, Dong Joo Oh. Korea University Guro Hospital, Seoul, Korea (Republic of).
AS-255
EP O S T E R A B S T R A C T S
The Clinical Effect of Oral Nicorandil on Long-Term Clinical Outcomes in Acute Myocardial Infarction. Kyung Hoon Cho1, Myung Ho Jeong1, Young Keun Ahn1, Jong Hyun Kim2, Shung Chull Chae3, Young Jo Kim4, Seung Ho Hur5, In Whan Seong6, Taek Jong Hong7, Dong Hoon Choi8, Myeong Chan Cho9, Chong Jin Kim10, Ki Bae Seung11, Wook Sung Chung11, Yang Soo Jang8, Seung-Woon Rha12, Jang Ho Bae13, Jeong Gwan Cho1, Seung Jung Park14, KAMIR Investigators15. 1Chonnam National University Hospital, Gwangju, Republic of Korea; 2Busan Hanseo Hospital, Busan, Republic of Korea; 3Kyungpook National University Hospital, Daegu, Republic of Korea; 4Yeungnam University Hospital, Daegu, Republic of Korea; 5Keimyung University Hospital Dongsan Medical Center, Daegu, Republic of Korea; 6Chungnam National University, Daejon, Republic of Korea; 7Busan National University Hospital, Busan, Republic of Korea; 8Yonsei University Severans Hospital, Seoul, Republic of Korea; 9Chungbuk National University Hospital, Cheongju, Republic of Korea; 10Kyunghee University Hospital, Seoul, Republic of Korea; 11The Catholic University of Korea, Seoul St. Mary’s Hospital, Seoul, Republic of Korea; 12Korea University Guro Hospital, Seoul, Republic of Korea; 13Konyang University Hospital, Daejon, Republic of Korea; 14Asan Medical Center, Seoul, Republic of Korea; 15Other KAMIR, investigators, Seoul, Republic of Korea. Background: This study examined the effect of oral nicorandil on long-term clinical outcomes after percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI). Methods: As part of the Korean Acute Myocardial Infarction Registry (KAMIR), we enrolled 5864 eligible patients with discharge medication undergoing a 1-year follow-up after PCI for AMI from October 2005 and January 2008. The patients were divided on the basis of prescription for oral nicorandil on discharge. The occurrences of death, MI, repeat PCI, and coronary artery bypass graft surgery (CABG) were collected over 1-year follow-up.
Background: Adjunctive cilostazol to dual antiplatelet therapy (triple antiplatelet therapy) is known to reduce restenosis and is associated with favorable clinical outcomes in diabetes. However, there is limited data related to the use of triple antiplatelet therapy in chronic stable angina patients with diabetes in real-world clinical practice. Methods: The study population consisted of 301 consecutive patients (excluding acute myocardial infarction [AMI] and those without diabetes) who underwent elective PCI with drug-eluting stents (DES) from April 2006 to February 2009. Usage of adjunctive cilostazol was at the physician’s discretion. Cilostazol was administered by 200-mg post-loading and then 100 mg twice daily for at least 1 month. Clinical and angiographic outcomes at 6 months in the triple-therapy group were compared with those of the dual antiplatelet group. Results: Of 301 patients, 111 (36.88%) received adjunctive cilostazol. Patients in the triple-therapy group had worse angiographic characteristics, including more left main, diffuse long, ostial lesions and calcified lesions, although this was not statistically significant. Multivariate analysis revealed that patients in the triple-therapy group had significantly fewer target vessel revascularizations and target lesion revascularizations. Angiographic outcomes were similar between the 2 groups. Although it was not statistically significant, there were 2 stent thromboses in the triple-therapy group, and no such event was seen in dual-therapy group (Table).
Conclusion: Diabetic patients presenting with chronic stable angina receiving cilostazol as adjunctive therapy along with dual anti-
108BThe American Journal of Cardiology姞 APRIL 28 –30 2010 ANGIOPLASTY SUMMIT ABSTRACTS/E-Poster