Cilostazol and Risk of Major Adverse Limb and Cardiovascular Events after Revascularisation for Peripheral Artery Disease.

IF 8.5 1区医学 Q1 PERIPHERAL VASCULAR DISEASE

European Journal of Vascular and Endovascular Surgery Pub Date : 2026-10-16 DOI:10.1016/j.ejvs.2026.10.012

Donna Shu-Han Lin, Hsu-Ping Wu, Wen-Jung Chung, Shu-Kai Hsueh, Po-Chao Hsu, Jen-Kuang Lee, Chun-Chi Chen, Hsuan-Li Huang

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引用次数: 0

Abstract

Objective: Patients with peripheral artery disease (PAD) remain at high risk of major adverse limb events (MALE) and cardiovascular events (MACE) after revascularisation. Cilostazol, a phosphodiesterase-3 inhibitor with antiplatelet and antiproliferative effects, reduces re-stenosis but its real world impact on clinical outcomes is uncertain. This retrospective, nationwide, propensity score matched cohort study evaluated the effectiveness and safety of cilostazol on MALE, MACE, and all cause mortality after lower limb revascularisation for PAD.

Methods: Using the Taiwan National Health Insurance Research Database, patients who underwent lower limb revascularisation for PAD from 2010 - 2023, with follow up through 2024 were identified. Patients with prior cilostazol use were excluded. 1:1 propensity score matching (n = 5 464 per group) adjusted for baseline differences. Cox regression and Fine-Gray competing risk models were used to evaluate outcomes. The comparison reflects cilostazol used with or without background antithrombotic therapy.

Results: Cilostazol use was associated with significantly lower risks of MALE (78.7 vs. 154.0 events/1 000 person-years; subdistribution hazard ratio [SHR] 0.50; 95% confidence interval [CI] 0.46 - 0.53) and MACE (97.9 vs. 117.1 events/1 000 person-years; hazard ratio [HR] 0.84; 95% CI 0.79 - 0.89). All cause mortality was also reduced (116.0 vs. 127.6 events/1 000 person-years; HR 0.91; 95% CI 0.86 - 0.96). Major bleeding did not differ significantly between groups (SHR 0.90; 95% CI 0.81 - 1.00), although the absolute rate was high in both groups (12.1% vs. 13.1%). Subgroup analysis showed greater limb benefit in patients not on other antiplatelet agents.

Conclusion: Cilostazol after PAD revascularisation was associated with lower risks of limb and cardiovascular events and mortality. These effects were observed without any increase in the rate of major bleeding, although this rate was high in both groups. Randomised trials focused on cardiovascular events are needed.

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西洛他唑与外周动脉疾病血运重建后主要不良肢体和心血管事件的风险。

目的：外周动脉疾病（PAD）患者在血运重建术后仍处于主要肢体不良事件（MALE）和心血管事件（MACE）的高风险。西洛他唑是一种具有抗血小板和抗增殖作用的磷酸二酯酶-3抑制剂，可减少再狭窄，但其对临床结果的实际影响尚不确定。这项回顾性的、全国性的、倾向评分匹配的队列研究评估了西洛他唑对PAD下肢血管重建术后MALE、MACE和全因死亡率的有效性和安全性。排除既往使用西洛他唑的患者。1:1倾向评分匹配（n = 5 464每组）调整基线差异。Cox回归和Fine-Gray竞争风险模型用于评估结果。比较反映了西洛他唑与或不使用背景抗血栓治疗。结果：西洛他唑的使用显著降低了MALE （78.7 vs. 154.0事件/ 1000人年；亚分布风险比[SHR] 0.50； 95%可信区间[CI] 0.46 - 0.53）和MACE （97.9 vs. 117.1事件/ 1000人年；风险比[HR] 0.84; 95% CI 0.79 - 0.89）的风险。全因死亡率也降低了（116.0 vs 127.6事件/ 1000人年；HR 0.91; 95% CI 0.86 - 0.96）。两组间大出血发生率无显著差异（SHR 0.90; 95% CI 0.81 - 1.00），但两组的绝对发生率均较高（12.1%对13.1%）。亚组分析显示，未使用其他抗血小板药物的患者肢体获益更大。结论：外周动脉血管重建术后使用西洛他唑可降低肢体和心血管事件及死亡率的风险。观察到这些效果并没有增加大出血的发生率，尽管两组的大出血发生率都很高。需要针对心血管事件的随机试验。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

European Journal of Vascular and Endovascular Surgery 医学-外科

CiteScore

6.80

自引率

15.80%

发文量

471

审稿时长

66 days

期刊介绍： The European Journal of Vascular and Endovascular Surgery is aimed primarily at vascular surgeons dealing with patients with arterial, venous and lymphatic diseases. Contributions are included on the diagnosis, investigation and management of these vascular disorders. Papers that consider the technical aspects of vascular surgery are encouraged, and the journal includes invited state-of-the-art articles. Reflecting the increasing importance of endovascular techniques in the management of vascular diseases and the value of closer collaboration between the vascular surgeon and the vascular radiologist, the journal has now extended its scope to encompass the growing number of contributions from this exciting field. Articles describing endovascular method and their critical evaluation are included, as well as reports on the emerging technology associated with this field.