Effect of Cilostazol on Patients With Diabetes Who Underwent Endovascular Treatment for Peripheral Artery Disease

Jung Joon Cha, Jae Young Cho, Subin Lim, Ju Hyeon Kim, Hyung Joon Joo, Jae Hyoung Park, Soon Jun Hong, Do Sun Lim, Hyungdon Kook, Seung Hun Lee, Young Guk Ko, Pil Ki Min, Jae Hwan Lee, Chang Hwan Yoon, In Ho Chae, Seung Whan Lee, Sang Rok Lee, Seung Hyuk Choi, Yoon Seok Koh, Cheol Woong Yu

Research output: Contribution to journalArticlepeer-review

Abstract

BACKGROUND: No large-scale study has compared the clinical impact of triple antiplatelet therapy (TAPT: aspirin, clopidogrel, and cilostazol) and dual antiplatelet therapy (DAPT) on adverse limb events in patients with diabetes after endovascular therapy (EVT) for peripheral artery disease. Thus, we investigate the effect of cilostazol added to a DAPT on the clinical outcomes after EVT in patients with diabetes using a nationwide, multicenter, real-world registry. METHODS AND RESULTS: A total of 990 patients with diabetes who underwent EVT were enrolled from the retrospective cohorts of a Korean multicenter EVT registry and were divided according to the antiplatelet regimen (TAPT [n=350; 35.4%] versus DAPT [n=640; 64.6%]). After propensity score matching based on clinical characteristics, a total of 350 pairs were compared for clinical outcomes. The primary end points were major adverse limb events, a composite of major amputation, minor amputation, and reintervention. For the matched study groups, the lesion length was 125.4±102.0 mm, and severe calcification was observed in 47.4%. The technical success rate (96.9% versus 94.0%; P=0.102) and the complication rate (6.9% versus 6.6%; P>0.999) were similar between the TAPT and DAPT groups. At 2-year follow-up, the incidence of major adverse limb events (16.6% versus 19.4%; P=0.260) did not differ between the 2 groups. However, the TAPT group showed less minor amputation than the DAPT group (2.0% versus 6.3%; P=0.004). In multivariate analysis, TAPT was an independent predictor of minor amputation (adjusted hazard ratio, 0.354 [95% CI, 0.158–0.794]; P=0.012). CONCLUSIONS: In patients with diabetes undergoing EVT for peripheral artery disease, TAPT did not decrease the incidence of major adverse limb events but may be associated with a decreased risk of minor amputation.

Original languageEnglish
Article numbere027334
JournalJournal of the American Heart Association
Volume12
Issue number12
DOIs
Publication statusPublished - 2023 Jun 20
Externally publishedYes

Bibliographical note

Publisher Copyright:
© 2023 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

Keywords

  • cilostazol
  • critical limb ischemia
  • diabetes
  • peripheral artery disease
  • triple antiplatelet therapy

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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