Background

The aim of the study was to investigate whether cilostazol can overcome adverse effect of smoking on clinical outcomes after percutaneous coronary intervention (PCI).

Methods

A total of 914 patients with successful drug-eluting stent (DES) implantation were randomly assigned to dual antiplatelet therapy (DAT: aspirin and clopidogrel, n=457) and triple antiplatelet therapy (TAT: DAT with cilostazol, n=457). The effect of smoking on 2 year major adverse cardio-cerebro-vascular events (MACCEs) in both TAT and DAT groups were evaluated.

Results

Total MACCEs were not significantly different between the 2 different anti-platelet regimens (9.8% in TAT versus 11.4% in DAT groups, p=0.45). But adverse effect of smoking on clinical outcomes was different between DAT versus TAT. Current smokers had higher MACCE than nonsmokers in DAT group (16.7% versus 9.5%, p=0.04). In TAT group, however, the adverse effect of smoking disappeared (9.2% versus 10.1%, p=0.85). Regarding the effect of smoking on antiplatelet effects of DAT or TAT, post-treatment platelet reactivity by P2Y12 reaction unit of current smokers was not significantly lower than that of nonsmokers in DAT group, whereas, in TAT group, it was significantly lower than that of nonsmokers (189±88 versus 216±89, p=0.01).

Conclusions

Adverse clinical effect of smoking may be overcome by addition of cilostazol on top of DAT after DES implantation, which may be driven by potentiation of cilostazol's antiplatelet effect by smoking.

Copyright © 2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.