Prevention of restenosis after angioplasty in small coronary arteries with probucol.
BACKGROUND
Restenosis remains the major limitation of coronary angioplasty. Coronary stents have reduced the incidence of restenosis in selected patients with relatively large vessels. No strategies to date have demonstrated a beneficial effect in vessels < 3.0 mm in diameter. We have shown in the MultiVitamins and Probucol (MVP) Trial that probucol, a potent antioxidant, reduces restenosis after balloon angioplasty. The purpose of this study was to determine whether the benefit of probucol therapy is maintained in the subgroup of patients with smaller coronary vessels.


RESULTS
We studied a subgroup of 189 patients included in the MVP trial who underwent successful balloon angioplasty of at least one coronary segment with a reference diameter < 3.0 mm. One month before angioplasty, patients were randomly assigned to one of four treatments: placebo, probucol (500 mg), multivitamins (beta-carotene 30000 IU, vitamin C 500 mg, and vitamin E 700 IU), or probucol plus multivitamins twice daily. The treatment was maintained until follow-up angiography was performed at 6 months. The mean reference diameter of this study population was 2.49+/-0.34 mm. Lumen loss was 0.12+/-0.34 mm for probucol, 0.25+/-0.43 mm for the combined treatment, 0.35+/-0.56 mm for vitamins, and 0.38+/-0.51 mm for placebo (P=.005 for probucol). Restenosis rates per segment were 20.0% for probucol, 28.6% for the combined treatment, 45.1% for vitamins, and 37.3% for placebo (P=.006 for probucol).


CONCLUSIONS
Probucol reduces lumen loss and restenosis rate after balloon angioplasty in small coronary arteries.
Rodés
J
J
Department of Medicine, Montreal Heart Institute, Québec, Canada.
Côté
G
G
Lespérance
J
J
Bourassa
M G
MG
Doucet
S
S
Bilodeau
L
L
Bertrand
O F
OF
Harel
F
F
Gallo
R
R
Tardif
J C
JC
D000368:Aged; D000800:Angioplasty, Balloon; D000924:Anticholesteremic Agents / Q000627:therapeutic use*; D000975:Antioxidants / Q000627:therapeutic use*; D017023:Coronary Angiography; D003327:Coronary Disease / Q000517:prevention & control* / Q000601:surgery*; D003331:Coronary Vessels / Q000601:surgery*; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011341:Probucol / Q000627:therapeutic use*; D012008:Recurrence; D012016:Reference Values; D016896:Treatment Outcome; D014815:Vitamins / Q000627:therapeutic use
D000924:Anticholesteremic Agents; D000975:Antioxidants; D014815:Vitamins; D011341:Probucol