Comparison between a sustained administration of carvedilol versus atenolol to reduce restenosis after coronary stenting.
BACKGROUND
Carvedilol is a direct inhibitor of vascular smooth muscle cell migration and proliferation through inhibition of mitogen-activated protein kinase activity and regulation of cell cycle progression. It produced an 84% suppression of neointimal hyperplasia in rat carotid angioplasty model, but no data are available regarding its effect on stent restenosis in patients. We tested whether a sustained oral administration of carvedilol reduces restenosis after coronary stenting in patients.


METHODS
One hundred fifty-nine patients were randomly assigned to receive either carvedilol (50 mg/d, n = 80) or atenolol (50 mg/d, n = 79) at least 1 day before stenting and continued on the same medication over a period of 3 months. The primary end point was angiographic restenosis (>50% diameter stenosis) at follow-up angiography.


RESULTS
Baseline clinical and angiographic variables were similar between the carvedilol and atenolol group. The carvedilol dose was tolerable in most patients but reduced in 3 patients because of hypotension or dizziness. Angiographic follow-up was done in 137 patients (86%), and restenosis rate was not different significantly between both groups (17.1% versus 19.4%, P =.732).


CONCLUSIONS
A sustained oral administration of carvedilol is not effective to reduce restenosis after stenting in patients. With carvedilol targeting regulators of cell cycle progression and having a profound neointimal inhibition with a high blood concentration in an animal study, further investigations with a stent-based delivery to achieve a high local concentration may be warranted.
Cha
Kwang Soo
KS
Department of Cardiology, Dong-A University Hospital, Busan, South Korea. kwangsoo@damc.or.kr
Kim
Moo Hyun
MH
Kim
Jin Woo
JW
Kim
Doo Il
DI
Kim
Hje Jin
HJ
Kim
Dong Soo
DS
Kim
Jong Seong
JS
D000284:Administration, Oral; D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage* / Q000627:therapeutic use; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D001262:Atenolol / Q000627:therapeutic use*; D002227:Carbazoles / Q000008:administration & dosage* / Q000627:therapeutic use; D000077261:Carvedilol; D003327:Coronary Disease / Q000628:therapy*; D023903:Coronary Restenosis / Q000517:prevention & control*; D005260:Female; D006801:Humans; D006965:Hyperplasia / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000628:therapy; D011412:Propanolamines / Q000008:administration & dosage* / Q000627:therapeutic use; D015607:Stents; D017539:Tunica Intima / Q000473:pathology
D000319:Adrenergic beta-Antagonists; D002227:Carbazoles; D011412:Propanolamines; D000077261:Carvedilol; D001262:Atenolol