Treatment with cilostazol prevents incidence of stroke in haemodialysis patients with peripheral artery disease: propensity score-adjusted analysis

Abstract

Background and objectives: Cilostazol, a selective inhibitor of phosphodiesterase 3, has been reported to have beneficial effects on preventing atherosclerotic events in general population. This study with a propensity score-adjusted analysis investigated the effects of cilostazol use on preventing incidence of stroke in haemodialysis (HD) patients with peripheral artery disease. Design, setting, participants, and measurements: This study consisted of 626 HD patients with a clinical diagnosis of peripheral artery disease. They were divided into two groups: patients receiving 100mg cilostazol twice daily in conjunction with standard therapy (n = 249 patients, cilostazol group) and those not administered cilostazol (n = 377 patients, control group). They were followed-up for up to 10 years, and data on incidence of stroke as the primary endpoint were collected. Also composite endpoints of major adverse events including all-cause mortality, non-fatal myocardial infarction, and stroke were evaluated. To adjust for baseline differences between the two groups, a propensity score analysis with all baseline valuables was performed. Results: By a propensity score adjustment, 10-year event-free survival rate from stroke was significantly higher in the cilostazol group compared to the control group [82.2% vs. 74.6%, hazard ratio (HR) 0.48; 95% confidence interval (CI) 0.25-0.92; P = 0.028]. Also, event-free rate from all-cause mortality was significantly higher in the cilostazol group than in the control group (64.9% vs 50.8%; HR = 0.55; 95% CI, 0.38–0.78, P = 0.0010). Freedom from composite endpoints of major adverse events was frequently seen in the cilostazol group than in the control group (58.7% vs 44.0%; HR = 0.52; 95% CI, 0.41–0.79, P = 0.0010). Even after adjusting for other confounders, treatment with cilostazol was an independent predictor of preventing stroke (HR 0.51; 95% CI 0.26-0.97, P = 0.040), all-cause mortality (HR 0.61; 95% CI 0.41-0.92, P = 0.018), and major adverse events (HR 0.64; 95% CI 0.45-0.91, P = 0.013). Conclusion: Cilostazol administration improves long-term clinical outcome in HD patients with PAD.