Cilostazol Prevents Coronary Artery Stent Restenosis By 40 Percent

Emory University
Wednesday, 19 November 2003

Emory Heart Center cardiologist William Weintraub, MD, Director of the Emory Center for Outcomes Research, will discuss the findings of the national "Cilostazol for RESTenosis" (CREST) study on Saturday, November 22, at the VEITHsymposium™, an international conference of vascular specialists held in New York from November 20 through November 23.

The CREST research found the drug cilostazol (Pletal) reduces in-stent restenosis (the renarrowing of arteries following angioplasty) by almost 40 percent over standard therapy alone -- a conclusion that could mark a significant new treatment option for coronary artery disease.

"The results of CREST have revealed that the drug cilostazol offers an inexpensive means to control restenosis, which is the major limitation of coronary stents," says Dr. Weintraub, who was co-investigator of the study along with John Douglas, MD, Director of Interventional Cardiology at Emory University, and David Holmes, MD, of the Mayo Clinic.

A multicenter, randomized, double-blind, placebo-controlled trial, CREST involved 705 patients enrolled at 19 clinical sites across the U.S who received a standard therapy of aspirin and clopidogrel plus a dose of cilostazol (a phosphodiesterase III inhibitor with multiple actions) or placebo after successful coronary stent implantation. Treatment with study medication (cilostazol or placebo) and aspirin was continued for six months.

Dr. Weintraub points out that the CREST study showed cilostazol to be efficacious in patients with diabetes and small blood vessels, two important subgroups that are among the most difficult to treat. "In addition, the benefit of cilostazol in preventing restenosis in all groups was achieved with no increase in complications or coronary stenting," he adds.

During angioplasty, the most commonly used procedure in the U.S. to treat potentially life-threatening coronary blockages, a balloon-tipped catheter pushes aside atherosclerotic plaques in arteries. Once the vessel has been widened and adequate blood flow is returned, stents (tiny mesh wire tubes) are frequently used to keep arteries open. However, renarrowing has proved to be a frequent problem following angioplasty and stenting; restenosis affects 300,000 coronary stent recipients in the United States each year. Patients who experience restenosis may require additional angioplasty procedures, another stent or bypass surgery.

"Cilostazol appears to be a safe and highly effective weapon in the war on heart disease that can potentially reduce the need for further invasive procedures following angioplasty," Dr. Weintraub says. "I look forward to sharing the important findings of CREST with my colleagues at the VEITHsymposium™."

Cilostazol (Pletal) is marketed by Otsuka America Pharmaceutical, Inc. with an indication for the treatment of intermittent claudication. Funding for the CREST study was provided by Otsuka America Pharmaceutical, Inc. in the form of an unrestricted research grant.

For more information, or to contact Emory University, see their website at: whsc.emory.edu