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Background: Reverse dipper, blood pressure (BP) rises during night-time, is a risk factor of increased cardiovascular events in hypertensive patients. However, we have little information whether reverse dipper in acute stage of cerebral infarction (CI) affects on the recurrence and mortality. We studied to assess the relationship between reverse dipper and adverse clinical outcomes in the acute stage of CI., Methods: We screened and enrolled consecutive patients with acute CI with ambulatory blood pressure monitoring (ABPM) within 2 weeks after admission from August 2001 to July 2005. According to systolic blood pressure (SBP) dropping pattern during night-time compared with daytime, we classified into extreme dipper (≥20%), dipper (≥10%, <20%), nondipper (≥0%, <10%), and reverse dipper (BP rises during night-time)., Results: We analyzed 426 patients (72 ± 13 years old, 255 men) and checked recurrence of CI or all-cause mortality for further 7.6 ± 3.1 years for checking of recurrence or all-cause mortality. Of 426 patients, 202 patients were nondippers (47%), 134 were reverse dippers (32%), 80 were dippers (19%), and 10 were extreme dippers (2%). During the follow-up period, 89 patients (21%) had recurrence of CI. After multivariate analysis, daytime SBP (hazard ratio = 1.014, P = .018) was the significant predictor of recurrence. There were 141 deaths (33%) in our study cohort. Multivariate analysis showed that age (hazard ratio = 1.106, P < .001), nocturnal mean heart rate (hazard ratio = 1.023, P = .004), and reverse dipper (hazard ratio = 1. 676, P = .007) were statistically significant., Conclusions: Reverse dipper and high night-time heart rate in the acute stage of CI were associated with total mortality during long-term follow-up. These findings suggest the clinical utility of ABPM in acute stage of CI., (Copyright © 2014 National Stroke Association. Published by Elsevier Inc. All rights reserved.)

Sarpogrelate and cilostazol are two commonly used adjunctive antiplatelet agents that also can be used to improve endothelial dysfunction. We compared the effects of sarpogrelate and cilostazol on endothelial dysfunction in active male smokers with flow-mediated dilatation (FMD). We enrolled and compared baseline and follow-up FMD in 20 young male smokers without any known cardiovascular diseases. Two participants who were initially medicated with cilostazol dropped out because of severe headache after taking medication. However, they continued the other experiment with sarpogrelate medication. Baseline endothelium-dependent dilatation (EDD) after reactive hyperemia was 7.5 % ± 1.9 % and endothelium-independent dilatation (EID) after sublingual administration of nitroglycerin was 13.3 % ± 3.4 %. After a 2-week treatment of cilostazol, follow-up EDD significantly increased (7.7 % ± 1.9 to 8.8 ± 2.0 %, P = 0.016), but follow-up EID changed insignificantly (13.2 % ± 3.5 to 12.5 % ± 3.9 %, P = 0.350). With the sarpogrelate treatment, follow-up EDD was significantly increased (7.4 % ± 1.9 % to 8.8 % ± 1.9 %, P = 0.021), but follow-up EID was similar (13.5 % ± 3.5 to 14.0 % ± 3.2 %, P = 0.427). There was no clinical significance between the two groups on follow-up EDD and EID (P = 0.984 and 0.212, respectively). However, the mean score of intensity of headache was significantly higher in the cilostazol group than in the sarpogrelate group (3.8 % ± 2.5 % vs 1.4 % ± 2.2 %, P = 0.005). EDD showed a similar significant increase with 2-week treatment of cilostazol and sarpogrelate. However, intensity of headaches was significantly higher in the cilostazol group.

Purpose: To evaluate intracranial hemodynamic stabilization patterns after carotid artery stenting (CAS) in patients having variable collateral developments before CAS., Methods: The hemodynamic and angiographic data of 62 patients (58 men; mean age 68.0±8.4 years) who underwent CAS for unilateral proximal internal carotid artery stenosis were analyzed. The patients had transcranial Doppler examinations before and at 1 and 90 days after CAS. Patients were classified according to pre-CAS mean blood flow velocity (MBFV) of the ipsilateral middle cerebral artery (MCA): low (<30 cm/s; n=17), normal (30 to 48 cm/s; n=26), or high (>48 cm/s; n=19). The collaterals from contralateral anterior and/or posterior circulations prior to CAS, the stabilization pattern of MBFV, and the pulsatility index (PI) after CAS were compared across the 3 groups., Results: The presence of collaterals was lowest in the low MBFV group (17.6% of patients) than in the normal (38.5%) or high (68.4%) MBFV groups (p=0.008). The low MBFV group exhibited an increase in MBFV and PI in the ipsilateral MCA at 1 and 90 days after CAS (p<0.05). By contrast, the high MBFV group exhibited a decrease in MBFV and no change in PI in the ipsilateral MCA up to 90 days after CAS (p<0.05). The normal MBFV group showed an increase in MBFV at post-CAS day 1 but a subsequent decrease at 90 days and an increase in PI in the ipsilateral MCA at 1 and 90 days post-CAS (p<0.05)., Conclusion: The pattern of post-CAS intracranial hemodynamic stabilization differs according to the pre-CAS MBFV in the ipsilateral MCA.

Purpose: To classify transcranial Doppler (TCD) spectral patterns and analyze the significance of the patterns in the determination of hemodynamic alterations occurring during filter-protected carotid artery stent (CAS) procedures., Methods: Data on middle cerebral artery (MCA) monitoring and post-CAS diffusion weighted magnetic resonance imaging (DWMRI) were reviewed for 53 patients (45 men; mean age 67.6 ± 8.3 years) who underwent TCD evaluation before CAS and TCD monitoring during the procedure. TCD spectral patterns were classified according to the hemodynamic changes that occurred after different portions of the CAS procedures. The relationships among the spectral patterns and the frequency and location of new DWMRI lesions were analyzed., Results: TCD spectral changes were classified into 4 patterns: (1) microemboli signals (53, 100%), (2) right-left collateral signals (31/53, 58%), (3) spectral suppression after balloon inflation (31/44, 70%), and (4) continuous spectral suppression after balloon removal (4/44, 9%). Even though microembolic signals were frequently observed during CAS, the new DWMRI lesions were more frequently observed outside of the cerebral territory (78%) rather than in the territory ipsilateral to CAS (47%). The presence of right-left collaterals was related to less severe balloon-related spectral suppression on ipsilateral MCA (p<0.05). Continuous spectral suppression appeared after stent deployment and balloon dilation and was immediately reversed after removal of the filter device., Conclusion: The spectral patterns classified in the present study may prove useful in anticipating CAS procedure-related hemodynamic alterations. Close hemodynamic observation using these spectral patterns could be helpful in preventing serious complications during CAS.

Cor pulmonale (CP) is defined as the structural and functional alternation of the right ventricle (RV) caused by primary disorders of the respiratory system. We aimed to differentiate acute CP complicated with massive pulmonary thromboembolism (PTE) from the chronic form due to severe chronic obstructive pulmonary disease (COPD) with strain analysis of RV in the emergency department. We included patients showing echocardiographic features of pulmonary hypertension in the emergency department. From March 2005 to July 2006, a total of 52 patients, 24 consecutive patients with acute CP (ten males, mean 69 ± 10 years) and 28 consecutive patients with chronic CP associated with severe COPD (22 males, mean 63 ± 14 years), were included. Echocardiographic data and strain analyses were obtained with GE Vivid 7. There was no statistical difference in age, fractional area change of RV, TR Vmax, and Tei index in both groups. However, more males were included in the chronic group. Midventricular systolic strain of RV was significantly increased in patients with acute CP. Regarding the midventricular systolic strain in the detection of acute CP by the receiver operating curve analysis, the best sensitivity and specificity were obtained when -12.2% was applied as the criterion (more than -12.2% for predicting an acute CP, the sensitivity, specificity, and accuracy were 83.3, 78.6, and 80.8%, respectively). Midventricular systolic strain of RV can be used in the differentiation between acute and chronic CPs in the emergency department.

Few studies have compared the ability of sodium bicarbonate plus N-acetylcysteine (NAC) and sodium chloride plus NAC to prevent contrast-induced nephropathy (CIN) in diabetic patients with impaired renal function undergoing coronary or endovascular angiography or intervention. Diabetic patients (n = 382) with renal disease (serum creatinine ≥1.1 mg/dl and estimated glomerular filtration rate <60 ml/min/1.73 m(2)) were randomly assigned to receive prophylactic sodium chloride (saline group, n = 189) or sodium bicarbonate (bicarbonate group, n = 193) before elective coronary or endovascular angiography or intervention. All patients received oral NAC 1,200 mg 2 times/day for 2 days. The primary end point was CIN, defined as an increase in serum creatinine >25% or an absolute increase in serum creatinine ≥0.5 mg/dl within 48 hours after contrast exposure. There were no significant between-group differences in baseline characteristics. The primary end point was met in 10 patients (5.3%) in the saline group and 17 (9.0%) in the bicarbonate group (p = 0.17), with 2 (1.1%) and 4 (2.1%), respectively, requiring hemodialysis (p = 0.69). Rates of death, myocardial infarction, and stroke did not differ significantly at 1 month and 6 months after contrast exposure. In conclusion, hydration with sodium bicarbonate is not superior to hydration with sodium chloride in preventing CIN in patients with diabetic nephropathy undergoing coronary or endovascular angiography or intervention., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Background: Meta-analysis of randomized trials showed superior efficacy and similar safety of drug-eluting stent over bare-metal stent in acute ST-elevation myocardial infarction (STEMI) patients. However, long-term relative outcomes of sirolimus- (SES) vs. paclitaxel-eluting stent (PES) have not been fully evaluated in randomized studies. This study compared long-term safety and efficacy of these two stents in STEMI., Methods: A total of 308 STEMI patients were randomly treated with SES (n = 154) or PES (n = 154). Three-year clinical outcomes were assessed. Primary outcome of interest was incidence of major adverse cardiac events (MACE) including death, myocardial infarction (MI), stent thrombosis or target vessel revascularization (TVR). Secondary outcome of interest was occurrence of very late stent thrombosis., Results: Both groups had similar baseline characteristics. During follow-up, there was no difference between the two groups in terms of death (6.5% for SES and 10.4% for PES, p = 0.22), MI (2.6% vs. 3.9%, p = 0.75), stent thrombosis (1.9% vs. 3.2%, p = 0.72), TVR (3.9% vs. 8.4%, p = 0.15) and MACE (12.3% vs. 18.8%, p = 0.12). Eight patients in overall population had stent thrombosis: definite 3, probable 1, and possible 4. Cumulative incidence of stent thrombosis was gradually increased; 0.6% at 30 days, 0.6% at 1 year, 1.6% at 2 years, and 2.6% at 3 years. Very late stent thrombosis, definite or probable, occurred in 0.6% for both., Conclusion: Among non-selected STEMI patients who underwent primary angioplasty, both SES and PES might be safe and SES showed similar three-year clinical outcomes compared to PES., (Copyright © 2009 Elsevier Ireland Ltd. All rights reserved.)

Objectives: We compared 4-year efficacy and safety of sirolimus-eluting stents (SES) and paclitaxel-eluting stents (PES) in patients with diabetes mellitus (DM)., Background: Four-year comparison of SES with PES in diabetic patients has not been evaluated in a randomized manner., Methods: This prospective, multicenter, randomized study compared SES (n = 200) and PES (n = 200) implantation in diabetic patients. We evaluated 4-year major adverse cardiac events (MACE) including death, myocardial infarction (MI), and target lesion revascularization (TLR)., Results: The 2 groups had similar baseline characteristics. At 2 years, TLR (3.5% vs. 11.0%, log-rank, p < 0.01) and MACE (3.5% vs. 12.5%, log-rank, p < 0.01) were significantly lower in SES versus PES group with no difference of death or MI. At 4 years there were no differences in death (3.0% vs. 5.0%, p = 0.45) or MI (1.5% vs. 1.0%, p = 0.99) between SES and PES group. The TLR (7.5% vs. 12.0%, log-rank, p = 0.10) and MACE (11.0% vs. 16.0%, log-rank, p = 0.10) were statistically not different between SES and PES group. At multivariate Cox regression, post-procedural minimal lumen diameter (hazard ratio [HR]: 0.44, 95% confidence interval [CI]: 0.24 to 0.81, p < 0.01), hypercholesterolemia (HR: 2.21, 95% CI: 1.29 to 3.79, p < 0.01), and use of intravascular ultrasound (HR: 0.51, 95% CI: 0.26 to 0.99, p = 0.049) were independent predictors of 4-year MACE., Conclusions: Superiority of SES over PES during 2 years was attenuated between 2 years and 4 years in diabetic patients. Use of intravascular ultrasound and larger post-procedural minimal lumen diameter were independent predictors of the improved long-term clinical outcomes., (Copyright © 2011 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)

Although cilostazol has decreased restenosis and target lesion revascularization (TLR) after drug-eluting stent implantation, it is not known if this effect is durable at 2 years. We analyzed 2 randomized studies (Drug-Eluting stenting followed by Cilostazol treatment reduces LAte REstenosis in patients with DIABETES mellitus and Drug-Eluting Stenting Followed by Cilostazol treatment reduces LAte REstenosis in patients with LONG native coronary lesions trials) in which 900 patients were randomly assigned to triple antiplatelet therapy (aspirin, clopidogrel, and cilostazol; triple group, n = 450) and dual antiplatelet therapy (aspirin and clopidogrel; standard group, n = 450) for 6 months in patients with diabetes or long lesions receiving drug-eluting stents. We evaluated 2-year major adverse cardiac events (MACEs) including death, myocardial infarction (MI), and TLR. Nine-month TLRs and MACEs were significantly decreased in the triple versus standard group. At 2 years, the triple group sowed significantly decreased TLRs (4.2% vs 9.1%, hazard ratio 0.45, 95% confidence interval 0.26 to 0.78, p = 0.004) and MACEs (5.6% vs 10.4%, hazard ratio 0.52, 95% confidence interval 0.32 to 0.84, p = 0.008) compared to the standard group with no differences in death and MI. In subgroup analysis, triple antiplatelet therapy decrease of 2-year TLR was favorable in all subgroups, especially in patients with paclitaxel-eluting stents, diabetes mellitus, small vessels, long lesions, and left anterior descending coronary artery lesions. In conclusion, compared to the standard group, initial benefit in decreases of 9-month TLRs and MACEs in the triple group was sustained at 2 years with no differences in death or MI. Triple antiplatelet therapy decrease of 2-year TLR was favorable in all subgroups, especially in patients with high-risk profiles., (Copyright 2010 Elsevier Inc. All rights reserved.)

Acute ST-segment elevation myocardial infarction occurs when the blood supply to a coronary artery is completely interrupted. The most common cause of the abrupt occlusion of a coronary artery is the rupture of a vulnerable atherosclerotic plaque. However, embolisms from any sources can be another cause of abrupt coronary obstruction. The authors report a case of acute ST-segment elevation myocardial infarction caused by a huge left atrial thrombus mimicking a myxoma.

Background: Stent fractures after drug-eluting stent (DES) implantation have not been evaluated sufficiently in patients with long coronary artery disease., Methods: This study comprised of 415 patients, who were enrolled in the Long-DES-II study and had a complete serial angiography both before and after procedure and also at follow-up. The lesions were > or =25 mm in length and were randomly treated with sirolimus-eluting stents (SES, 210 lesions) or paclitaxel-eluting stent (205 lesions)., Results: DES fracture was identified in 7 lesions (1.7%): 1 minor, 3 moderate, and 3 severe fractures. Most of the fractures occurred in patients who received SES (85.7%) and in the right coronary artery (RCA) lesions (71.4%). Lesions with fracture had a smaller minimal lumen diameter before procedure than lesions without fracture (0.38+/-0.55 vs. 0.71+/-0.46 mm, p=0.043). However, acute gain (2.28+/-0.39 vs. 1.44+/-0.60 mm, p=0.001) and late loss (0.81+/-0.49 vs. 0.42+/-0.50 mm, p=0.033) in analysis segment were greater in lesions with fracture. By multivariate analysis, the independent predictor of fracture was the RCA lesion (Odds ratio, 7.81; 95% CI, 1.45 approximately 42.04; p=0.017). Although one patient had an intermediate angiographic narrowing at the fracture site, there was no adverse cardiac event related with fracture., Conclusions: The incidence of stent fracture in long DES implantation was not common and was associated with SES implantation or RCA lesions. Fortunately, the clinical prognosis of DES fracture was somewhat benign.

Objectives: The aim of this study was to compare the effectiveness of sirolimus-eluting stents (SES) and paclitaxel-eluting stents (PES) in patients with diabetes mellitus (DM)., Background: Drug-eluting stent implantation significantly improved the angiographic and clinical outcomes compared with bare-metal stent implantation in diabetic patients. However, comparison of SES with PES in diabetic patients has not been sufficiently evaluated., Methods: This prospective, multicenter, randomized study compared SES (n = 200) and PES implantation (n = 200) for diabetic patients (n = 400). The primary end point was in-segment restenosis at 6 months according to intention-to-treat principle., Results: The 2 groups had similar baseline clinical and angiographic characteristics. Six-month in-stent (3.4% vs. 18.2%, p < 0.001) and in-segment restenosis (4.0% vs. 20.8%, p < 0.001) and 9-month target lesion revascularization (2.0% vs. 7.5%, p = 0.017) were significantly lower in the SES versus the PES group. The incidence of death (0% in SES vs. 0.5% in PES, p = 0.999) or myocardial infarction (0.5% in SES vs. 0.5% in PES, p = 0.999) at 9-month follow-up was not statistically different between the 2 groups. Major adverse cardiac events including death, myocardial infarction, and target lesion revascularization at 9 months (2.0% vs. 8.0%, p = 0.010) were lower in the SES versus the PES group., Conclusions: Sirolimus-eluting stent implantation is superior in reducing angiographic restenosis and improving 9-month clinical outcomes in patients with DM and coronary artery disease compared with PES implantation.

Background: Assessment of right ventricular (RV) systolic function remains difficult because of the RV's complex shape. We aimed to evaluate RV systolic function with strain analysis in patients with acute pulmonary thromboembolism (PTE)., Patients and Methods: From March 2005 to June 2006, 28 consecutive patients with acute PTE were included in this study. After excluding four patients, three with recurrent episodes of PTE and one with permanent pacemaker, the remaining 24 patients (10 males, mean age 69.0+/-10 years) were analyzed., Results: Mean RV fractional area change (RVFAC) was 20.1+/-8.7%; RV Tei index was 0.86+/-0.23; tricuspid annular plane systolic excursion (TAPSE) was 1.56+/-0.31 cm; and TR Vmax was 3.6+/-0.4 m/s at the time of diagnosis. Midventricular peak systolic strain of RV was markedly decreased (base: -18.0+/-6.6%, midventricle: -5.4+/-12.8%, apex: -10.6+/-8.1%). After treatment, follow-up echocardiographic data were obtained from 20 patients (mean: 11.0+/-8.2 days, duration: 4-34 days). Mean RVFAC, RV Tei index, TAPSE and TR Vmax were significantly improved (P<0.001). Midventricular peak systolic strains of RV were also significantly improved (base: -20.9+/-7.0%, P=0.055, midventricle: -21.1+/-6.8%, P<0.001, apex: -12.7+/-8.1%, P=0.314). Midventricular peak systolic strain of RV showed significant negative correlation with RVFAC (r=-0.660, P<0.001) and TAPSE (r=-0.642, P<0.001). Also, the RV Tei index showed significant correlation with RVFAC (r=-0.646, P<0.001) and TAPSE (r=-0.647, P<0.001)., Conclusions: Midventricular peak systolic strain and RV Tei index decreased in the patients with acute PTE and improved after stabilization. These values can therefore be used to assess RV systolic function in patients with acute PTE.

Objectives: We sought to evaluate the impact of cilostazol on neointimal hyperplasia after drug-eluting stent (DES) implantation in patients with diabetes mellitus (DM)., Background: Although cilostazol has reduced the extent of neointimal hyperplasia and restenosis in patients after bare-metal stent implantation, it is not known whether this effect occurs after DES implantation in diabetic patients., Methods: This randomized, multicenter, prospective study compared triple antiplatelet therapy (aspirin, clopidogrel, and cilostazol, triple group, n = 200) and dual antiplatelet therapy (aspirin and clopidogrel, standard group, n = 200) for 6 months in patients with DM receiving DES. The primary end point was in-stent late loss at 6 months., Results: The 2 groups had similar baseline clinical and angiographic characteristics. The in-stent (0.25 +/- 0.53 mm vs. 0.38 +/- 0.54 mm, p = 0.025) and in-segment (0.42 +/- 0.50 mm vs. 0.53 +/- 0.49 mm, p = 0.031) late loss were significantly lower in the triple versus standard group, as were 6-month in-segment restenosis (8.0% vs. 15.6%, p = 0.033) and 9-month target lesion revascularization (TLR) (2.5% vs. 7.0%, p = 0.034). At 9 months, major adverse cardiac events, including death, myocardial infarction, and TLR, tended to be lower in the triple than in the standard group (3.0% vs. 7.0%, p = 0.066). Multivariate analysis showed that sirolimus-eluting stents and the use of cilostazol were strong predictors of reduced restenosis or TLR., Conclusions: Triple antiplatelet therapy after DES implantation decreased angiographic restenosis and extent of late loss, resulting in a reduced risk of 9-month TLR compared with dual antiplatelet therapy in diabetic patients.

Background: Although previous studies have examined the efficacy of pitavastatin, its tolerability and effects on lipid concentrations have not been compared with those of atorvastatin in a multicenter, randomized study., Objective: This trial compared the efficacy and tolerability of pitavastatin and atorvastatin in hypercholesterolemic Korean adults., Methods: This 8-week, multicenter, randomized, open-label, dose-titration study was conducted at 18 clinical centers in Korea between May 2005 and February 2006. After a 4-week dietary lead-in period, patients with hypercholesterolemia were randomized to receive either pitavastatin 2 mg/d or atorvastatin 10 mg/d. Patients who had not reached the low-density lipoprotein cholesterol (LDL-C) goal by week 4 received a double dose of the assigned medication for an additional 4 weeks. Efficacy was evaluated in terms of achievement of the National Cholesterol Education Program Adult Treatment Panel III LDL-C goals and changes from baseline in other lipids and high-sensitivity C-reactive protein (hs-CRP). The tolerability profile was assessed by physical and electro-cardiographic examinations, laboratory tests, and recording adverse reactions at all visits., Results: A total of 268 patients were randomized to treatment, and 222 (82.8%) completed the study (149 women, 73 men; mean age, 59 years; mean weight, 63.5 kg). At the end of the study, there was no significant difference between the pitavastatin and atorvastatin groups in the proportion of patients achieving the LDL-C goal (92.7% [102/110] vs 92.0% [103/112], respectively). In addition, there were no significant differences between groups in terms of the percent changes from baseline in LDL-C, total cholesterol, triglycerides, high-density lipoprotein cholesterol (HDL-C), or hs-CRP. Twenty-six of 136 patients (19.1%) taking pitavastatin reported 35 treatment-emergent adverse reactions; 33 of 132 patients (25.0%) taking atorvastatin reported 39 treatment-emergent adverse reactions. Elevations in creatine kinase were observed in 6 patients (4.4%) in the pitavastatin group and 7 patients (5.3%) in the atorvastatin group. There were no serious adverse drug reactions in either group., Conclusions: In these adult Korean patients with hypercholesterolemia, pitavastatin and atorvastatin did not differ significantly in terms of the proportions of patients achieving the LDL-C goal; reductions in LDL-C, total cholesterol, and triglycerides; or increases in HDL-C. Both drugs were well tolerated.

To evaluate the impact of cilostazol on neointimal hyperplasia after drug-eluting stent (DES) implantation for long coronary lesions, we performed a randomized multicenter prospective study comparing triple antiplatelet therapy (aspirin, clopidogrel, and cilostazol; triple group, n = 250) and dual antiplatelet therapy (aspirin and clopidogrel; standard group, n = 250) for 6 months in patients with long lesions (> or =25 mm) requiring a long DES (> or =32 mm). The primary end point was in-stent late loss at 6-month angiography. The 2 groups had similar baseline clinical and angiographic characteristics. In-stent late loss (0.22 +/- 0.48 mm vs 0.32 +/- 0.51 mm, p = 0.031) and in-segment late loss (0.34 +/- 0.49 mm vs 0.51 +/- 0.49 mm, p = 0.001) at 6-month follow-up angiography were significantly lower in the triple group versus the standard group. There was a trend toward lower rates of in-segment restenosis in the triple group versus the standard group (6.7% vs 11.2%, p = 0.104). Target lesion revascularization (TLR; 2.8% vs 6.8%, p = 0.036) and major adverse cardiac events (2.8% vs 7.6%, p = 0.016), including death, myocardial infarction, and TLR at 9 months were significantly lower in the triple group than in the standard group. At 9 months, the 2 groups had similar rates of stent thrombosis (0.4% vs 0.4%, p = 0.999), death (0% vs 0.8%, p = 0.499), and myocardial infarction (0.4% vs 0.4%, p = 0.999). In conclusion, cilostazol significantly reduced late loss at 6 months after DES implantation and the occurrence of TLR and major adverse cardiac events in patients with long coronary lesions.