title: Effect of angiotensin-converting enzyme inhibition on restenosis after coronary stenting.
abstract: The Plasma level of angiotensin-converting enzyme (ACE) has been identified as a major risk factor for restenosis after coronary stent implantation in selected patients; ACE inhibition may therefore contribute to prevent its occurrence. The effect of oral ACE inhibition at conventional doses was analyzed retrospectively in a series of 897 patients with ischemia who received >or=1 coronary stent on 998 lesions and underwent angiographic follow-up; no exclusion criteria were introduced in this analysis. The restenosis rate in 282 patients (31.4%) taking ACE inhibitors was 36.6% compared with 22.9% in 615 non-ACE-inhibited patients (p = 0.00001, odds ratio [OR] 1.94, 95% confidence interval [CI] 1.45 to 2.59), and the late loss in minimum lumen diameter was 1.25 +/- 0.8 versus 0.96 +/- 0.8 mm, respectively (p = 0.0001). During univariate analysis, a negative effect of the drug on restenosis was observed in all subgroups of patients (i.e., hypertensives, diabetics, women, and patients with previous myocardial infarction). Similar effects were observed independently of the ACE gene insertion/deletion polymorphism. During multivariate analysis, ACE inhibition was confirmed as an independent risk factor for restenosis (OR 1.84, 95% CI 1.35 to 2.51, p = 0.0001). Other predictors were the implantation of multiple stents (OR 2.41, 95% CI 1.60 to 3.64, p <0.0001), diabetes (OR 2.34, 95% CI 1.61 to 3.41, p <0.0001), and vessel reference diameter before angioplasty (OR 0.51, 95% CI 0.38 to 0.69, p <0.0001). Although unexplained and apparently contradictory, our data suggest that the use of conventional oral doses of ACE inhibitors in a "real-world" population who underwent coronary stent implantation increases the incidence of in-stent restenosis. Such a finding does not negate the known clinical benefits of ACE inhibitors, but it may deserve attention when a patient treated with ACE inhibitors becomes a candidate for stent implantation.
authors.affiliation: Division of Cardiology, Universitá del Piemonte Orientale, Ospedale Maggiore della Caritá, Novara, Italy.
authors.forename: Flavio
authors.initials: F
authors.lastname: Ribichini
authors.forename: William
authors.initials: W
authors.lastname: Wijns
authors.forename: Valeria
authors.initials: V
authors.lastname: Ferrero
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Matullo
authors.forename: Terenzio
authors.initials: T
authors.lastname: Camilla
authors.forename: Mauro
authors.initials: M
authors.lastname: Feola
authors.forename: Simonetta
authors.initials: S
authors.lastname: Guarrera
authors.forename: Antonello
authors.initials: A
authors.lastname: Vado
authors.forename: Alberto
authors.initials: A
authors.lastname: Piazza
authors.forename: Eugenio
authors.initials: E
authors.lastname: Uslenghi
mesh_terms: D000704:Analysis of Variance; D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D023903:Coronary Restenosis / Q000000981:diagnostic imaging / Q000517:prevention & control*; D005260:Female; D005838:Genotype; D006801:Humans; D008297:Male; D008875:Middle Aged; D007703:Peptidyl-Dipeptidase A / Q000097:blood / Q000235:genetics; D011859:Radiography; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D007703:Peptidyl-Dipeptidase A