Rationale and design of the randomized, multicenter, cilostazol for RESTenosis (CREST) trial

John S. Douglas, William S. Weintraub, David Holmes

Research output: Contribution to journalReview article

16 Citations (Scopus)

Abstract

Restenosis of a segment of diseased coronary artery following metallic stenting is a common clinical problem and a major limitation of the procedure. Systemic pharmacologic interventions to deal with this problem have met with little success. Several small studies suggest that cilostazol, a phosphodiesterase III inhibitor whose pharmacologic properties include antiplatelet, antithrombotic, and vasodilatory effects; a beneficial effect on serum lipids; and in vitro inhibition of smooth muscle cell proliferation, may help prevent platelet aggregation and impede the accumulation of new intimal tissue in the stented artery. The Cilostazol for RESTenosis (CREST) trial will aim to evaluate more definitively the ability of cilostazol to prevent restenosis following uncomplicated stent implantation for de novo coronary artery stenosis. In this randomized, double-blind, multicenter study, 700 patients will receive clopidogrel, aspirin, and either cilostazol or placebo after successful intracoronary stent implantation. The primary endpoint is minimal luminal diameter (MLD) of the first lesion stented after 6 months; secondary endpoints include MLD in all lesions, mean percent diameter stenosis, target lesion revascularization, and major angiographic endpoints. Safety endpoints are abnormal complete blood count and liver function tests at 1, 3, and 6 months. The trial has been initiated, and enrollment is anticipated to be concluded in 2003. Cilostazol has properties that may reduce or avert in-stent coronary restenosis. The CREST trial is a large, rigorously conducted trial that may corroborate the favorable effects of cilostazol on coronary stent restenosis suggested by earlier studies.

Original languageEnglish (US)
Pages (from-to)451-454
Number of pages4
JournalClinical Cardiology
Volume26
Issue number10
DOIs
StatePublished - Oct 1 2003

Fingerprint

Stents
Coronary Restenosis
clopidogrel
Type 3 Cyclic Nucleotide Phosphodiesterases
Tunica Intima
Phosphodiesterase Inhibitors
Blood Cell Count
Coronary Stenosis
Liver Function Tests
cilostazol
Platelet Aggregation
Double-Blind Method
Aspirin
Multicenter Studies
Smooth Muscle Myocytes
Coronary Artery Disease
Pathologic Constriction
Arteries
Placebos
Cell Proliferation

Keywords

  • Cilostazol
  • Coronary stent
  • Restenosis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Rationale and design of the randomized, multicenter, cilostazol for RESTenosis (CREST) trial. / Douglas, John S.; Weintraub, William S.; Holmes, David.

In: Clinical Cardiology, Vol. 26, No. 10, 01.10.2003, p. 451-454.

Research output: Contribution to journalReview article

Douglas, John S. ; Weintraub, William S. ; Holmes, David. / Rationale and design of the randomized, multicenter, cilostazol for RESTenosis (CREST) trial. In: Clinical Cardiology. 2003 ; Vol. 26, No. 10. pp. 451-454.
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