A Randomized Study Assessing the Effects of Pretreatment with Cilostazol on Periprocedural Myonecrosis after Percutaneous Coronary Intervention
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Purpose: It is unknown whether cilostazol pretreatment reduces postprocedural myonecrosis (PPMN). Cilostazol pretreatment reduces PPMN after percutaneous coronary intervention (PCI). Materials and Methods: A total of 120 patients with stable angina scheduled for elective PCI were randomly assigned to a 7-day pretreatment with Cilostazol (200 mg/day) or to a control group. Creatine kinase-MB (CK-MB) and cardiac troponin I (cTnI) levels were measured at baseline and at 6 and 24 hours after PCI. The primary end-point was the occurrence of PPMN, defined as any CK-MB elevation above the upper normal limit (UNL). Aspirin and clopidogrel were co-administered for 7 days before PCI, and resistance to these agents was then assayed using the VerifyNow System. Results: There was no difference in baseline characteristics between the final analyzable cilostazol (n=54) and the control group (n=56). Despite a significantly greater % inhibition of clopidogrel in the cilostazol group (39±23% versus 25±22%, p=0.003), the incidence of PPMN was similar between the cilostazol group (24%) and the control group (25%, p=1.000). The rate of CK-MB elevation at ≥3 times UNL was also similar between the two groups (6% versus 5%, p=0.583). The incidence of cTnI increase over the UNL or to 3 times the UNL was not different between the two groups. There was no significant difference in terms of the rate of adverse events during follow-up, although the cilostazol group showed a tendency to have a slightly higher incidence of entry site hematoma. Conclusion: This trial demonstrated that adjunctive cilostazol pretreatment might not significantly reduce PPMN after elective PCI in patients with stable angina.
Abstract
Purpose: It is unknown whether cilostazol pretreatment reduces postprocedural myonecrosis (PPMN). Cilostazol pretreatment reduces PPMN after percutaneous coronary intervention (PCI). Materials and Methods: A total of 120 patients with stable angina scheduled for elective PCI were randomly assigned to a 7-day pretreatment with Cilostazol (200 mg/day) or to a control group. Creatine kinase-MB (CK-MB) and cardiac troponin I (cTnI) levels were measured at baseline and at 6 and 24 hours after PCI. The primary end-point was the occurrence of PPMN, defined as any CK-MB elevation above the upper normal limit (UNL). Aspirin and clopidogrel were co-administered for 7 days before PCI, and resistance to these agents was then assayed using the VerifyNow System. Results: There was no difference in baseline characteristics between the final analyzable cilostazol (n=54) and the control group (n=56). Despite a significantly greater % inhibition of clopidogrel in the cilostazol group (39±23% versus 25±22%, p=0.003), the incidence of PPMN was similar between the cilostazol group (24%) and the control group (25%, p=1.000). The rate of CK-MB elevation at ≥3 times UNL was also similar between the two groups (6% versus 5%, p=0.583). The incidence of cTnI increase over the UNL or to 3 times the UNL was not different between the two groups. There was no significant difference in terms of the rate of adverse events during follow-up, although the cilostazol group showed a tendency to have a slightly higher incidence of entry site hematoma. Conclusion: This trial demonstrated that adjunctive cilostazol pretreatment might not significantly reduce PPMN after elective PCI in patients with stable angina.
참고문헌 (20)
- Nallamothu BK, "Periprocedural myocardial infarction and mortality: causality versus association", J Am Coll Cardiol, 42, pp.1412~1414 (2003)
- Pasceri V, "ARMYDA Investigators. Randomized trial of atorvastatin for reduction of myocardial damage during coronary intervention: results from the ARMYDA (Atorvastatin for Reduction of MYocardial Damage during Angioplasty) study", Circulation, 110, pp.674~678 (2004)
- Bhatt DL, "Does creatinine kinase-MB elevation after percutaneous coronary intervention predict outcomes in 2005? Periprocedural cardiac enzyme elevation predicts adverse outcomes", Circulation, 112, pp.906~915 (2005)
- Cavallini C, "Impact of the elevation of biochemical markers of myocardial damage on long-term mortality after percutaneous coronary intervention: results of the CK-MB and PCI study", Eur Heart J, 26, pp.1494~1498 (2005)
- Patti G, "Randomized trial of high loading dose of clopidogrel for reduction of periprocedural myocardial infarction in patients undergoing coronary intervention: results from the ARMYDA-2 (Antiangiography platelet therapy for Reduction of MYocardial Damage during Angioplasty) study", Circulation, 111, pp.2099~2106 (2005)
- Claeys MJ, "Does pre-treatment with aspirin and loading dose clopidogrel obviate the need for glycoprotein IIb", IIIa antagonists during elective coronary stenting? A focus on peri-procedural myonecrosis, 2005, pp.26, 567~575
- Goto S, "Cilostazol: potential mechanism of action for antithrombotic effects accompanied by a low rate of bleeding", Atheroscler Suppl, 6, pp.3~11 (2005)
- Shim CY, "The clopidogrel resistance can be attenuated with triple antiplatelet therapy in patients undergoing drug-eluting stents implantation", International Journal Of Cardiology, 134(3), pp.351~355 (2009), Elsevier BV
- Jeong YH, "Randomized Comparison of Adjunctive Cilostazol Versus High Maintenance Dose Clopidogrel in Patients With High Post-Treatment Platelet Reactivity", JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 53(0), pp.2009~1109 (2009), ELSEVIER SCIENCE INC
- Thygesen K, "Joint ESC", ACCF, WHF Task Force for the Redefinition of Myocardial Infarction. Universal definition of myocardial infarction, pp.J Am Coll Cardiol, 2007[DOI]
- Chen WH, "Aspirin resistance is associated with a high incidence of myonecrosis after non-urgent percutaneous coronary intervention despite clopidogrel pretreatment", J Am Coll Cardiol, 43, pp.1122~1126 (2004)
- "An international randomized trial comparing four thrombolytic strategies for acute myocardial infarction. The GUSTO investigators", N Engl J Med, 329, pp.673~682 (1993)
- Mehta SK, "Bleeding in patients undergoing percutaneous coronary intervention: the development of a clinical risk algorithm from the National Cardiovascular Data Registry", Circ Cardiovasc Interv, 2, pp.222~229 (2009)
- Pache J, "Clopidogrel therapy in patients undergoing coronary stenting: value of a high-loading-dose regimen", Catheter Cardiovasc Interv, 55, pp.436~441 (2002)
- Liu Y, "Cilostazol (pletal): a dual inhibitor of cyclic nucleotide phosphodiesterase type 3 and adenosine uptake", Cardiovasc Drug Rev, 19, pp.369~386 (2001)
- Lee SW, "Comparison of cilostazol and clopidogrel after successful coronary stenting", Am J Cardiol, 95, pp.859~862 (2005)
- Lee SW, "Triple versus dual antiplatelet therapy after coronary stenting: impact on stent thrombosis", J Am Coll Cardiol, 46, pp.1833~1837 (2005)
- Buch AN, "Measuring aspirin resistance, clopidogrel responsiveness, and postprocedural markers of myonecrosis in patients undergoing percutaneous coronary intervention", Am J Cardiol, 99, pp.1518~1522 (2007)
- Matetzky S, "Clopidogrel resistance is associated with increased risk of recurrent atherothrombotic events in patients with acute myocardial infarction", Circulation, 109, pp.3171~3175 (2004)
- Cutlip DE, "Does creatinine kinase-MB elevation after percutaneous coronary intervention predict outcomes in 2005? Cardiac enzyme elevation after successful percutaneous coronary intervention is not an independent predictor of adverse outcomes", Circulation, 112, pp.916~922 (2005)