title: Quinapril prevents restenosis after coronary stenting in patients with angiotensin-converting enzyme D allele.
abstract: Restenosis after coronary artery stent implantation is attributed chiefly to intimal hyperplasia, which is prevented experimentally by angiotensin-converting enzyme (ACE) inhibitors. Therefore, the present study investigated whether the effect of quinapril, a tissue-specific ACE inhibitor, on the prevention of coronary restenosis differs according to ACE polymorphism. One hundred consecutive patients with successful stent implantation were randomly assigned to quinapril and control groups. Both follow-up angiography and ACE polymorphism analysis were obtained from 92 patients (control, 46; quinapril treatment, 46). The prevalence of risk factors did not differ statistically according to quinapril treatment or ACE genotypes. There was no statistically significant difference in the occurrence of restenosis 6 months after stenting between the groups. Quantitative coronary angiography revealed that quinapril treatment resulted in significantly higher minimal lumen diameter and significantly lower percent diameter stenosis (22.9 +/- 22.6 vs 37.1 +/- 19.7% in the control group, p < 0.05) in patients with the D allele although there was no difference in those with the II genotype. In addition, intravascular ultrasound revealed that quinapril treatment significantly prevented the loss of minimal lumen cross-sectional area and the increase in percent area stenosis (34.5 +/- 14.0 vs 53.3 +/- 16.4% in the control group, p < 0.05) in patients with the D allele compared to those with the II genotype. These results suggest that the administration of ACE inhibitors for the attenuation of lumen loss after coronary stent implantation is best for subjects with the D allele of the ACE genotype.
authors.affiliation: Second Department of Internal Medicine II, Nagoya University School of Medicine, Japan. kenji@med.nagoya-u.ac.jp
authors.forename: Kenji
authors.initials: K
authors.lastname: Okumura
authors.forename: Takahito
authors.initials: T
authors.lastname: Sone
authors.forename: Junichiro
authors.initials: J
authors.lastname: Kondo
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Tsuboi
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Mukawa
authors.forename: Michitaka
authors.initials: M
authors.lastname: Tsuzuki
authors.forename: Hajime
authors.initials: H
authors.lastname: Imai
authors.forename: Hiroki
authors.initials: H
authors.lastname: Kamiya
authors.forename: Yukio
authors.initials: Y
authors.lastname: Mabuchi
authors.forename: Hideo
authors.initials: H
authors.lastname: Matsui
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Hayakawa
mesh_terms: D000368:Aged; D000483:Alleles; D015906:Angioplasty, Balloon, Coronary; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D015992:Body Mass Index; D003327:Coronary Disease / Q000628:therapy*; D023903:Coronary Restenosis / Q000235:genetics* / Q000517:prevention & control*; D006801:Humans; D007546:Isoquinolines / Q000627:therapeutic use*; D008875:Middle Aged; D007703:Peptidyl-Dipeptidase A / Q000235:genetics*; D011355:Prodrugs / Q000627:therapeutic use; D000077583:Quinapril; D012307:Risk Factors; D012907:Smoking; D015607:Stents; D044005:Tetrahydroisoquinolines
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D007546:Isoquinolines; D011355:Prodrugs; D044005:Tetrahydroisoquinolines; D007703:Peptidyl-Dipeptidase A; D000077583:Quinapril