Background: It is unclear whether adjunctive Cilostazol (Pletaal짰) to dual antiplatelet therapy (triple antiplatelet) can provide additional protection in preventing post-procedural myonecrosis as assessed by established cardiac biomarkers and clinical outcomes in patients (pts) undergoing elective percutaneous coronary intervention (PCI) with drug-eluting stent (DES) in real-world clinical practice. Methods: The study population consisted of 969 consecutive pts who underwent PCI with DES. Pts presenting with acute myocardial infarction (AMI) or higher CKMB and Troponin-I than upper normal values were excluded. Usage of adjunctive Cilostazol to dual antiplatelet regimen was depending on physician���s discretion. Cilostazol was administered by 200mg post-loading and maintained 10mg bid for at least one month. CK-MB, Troponin-I and BNP were serially measured at pre and post PCI and compared between the triple and dual antiplatelet groups. Results: Out of 969 enrolled pts, 360 pts (37.2%) received Triple and 669 pts (62.9%) Dual therapy. Pts with Cilostazol group had worse baseline characteristics including more bifurcation (35.6% vs. 28.7 %, P=0.028), left main (8.3% vs. 2.3%, P<0.001), diffuse long (31.1% vs. 25.8%, P=0.042) and Ostial Lesions (21.7% vs. 14.1%, P=0.002). Cilostazol group also had higher baseline CK-MB levels and there was a trend toward higher baseline Troponin-I levels. Despite of the worse angiographic characteristics in Cilostazol group, post-procedural myocardial necrosis as assessed by biomarkers and incidence of MI were similar to those of pts with no Cilostazol group (Table).Conclusion: Use of adjunctive Cilostazol at least for a month in pts undergoing elective PCI with DES appears to be safe and showed similar incidence of post-procedural myonecrosis