L-arginine supplementation does not inhibit neointimal formation after coronary stenting in human beings: an intravascular ultrasound study.
BACKGROUND
In-stent restenosis results from neointimal tissue proliferation. L-arginine supplementation improves endothelial function and reduces neointimal formation after arterial injury in animals. The aim of the study was to assess the influence of L-arginine administration on neointimal proliferation after coronary stenting in human beings.


METHODS
We performed a prospective, randomized, double-blinded, placebo-controlled study in 60 men without diabetes. L-arginine/placebo was administered intravenously 12 hours before percutaneous coronary intervention (200 mg/kg for 240 minutes), during the procedure (200 mg/kg for 240 minutes), and intracoronarily immediately before stent implantation (500 mg for 10 minutes), and it was followed by oral treatment for next 2 weeks (6.0 g/d). By quantitative coronary angiography, late lumen loss, and intravascular ultrasound, neointimal volume and percent neointimal volume were calculated after 7 months of follow-up to assess neointimal formation.


RESULTS
There were no differences in baseline clinical or angiographic characteristics between the two groups. Intravenous infusion of L-arginine increased plasma L-arginine concentrations 6-fold compared with placebo (661 +/- 264 vs 107 +/- 71 mmol/L, P <.001). During the 2-week period of oral treatment with L-arginine there was a sustained, significant increase of plasma L-arginine level (150 +/- 50 vs 100 +/- 17, P <.001, 135 +/- 42 vs 89 +/- 27, P <.001, respectively, on days 7 and 14 in the L-arginine group vs placebo). However, at 7-month follow-up, there was no difference in neointimal formation measured both by quantitative coronary angiography and intravascular ultrasound between the study groups.


CONCLUSIONS
Chronic systemic L-arginine administration has no effect on neointimal formation after coronary stenting in human beings.
Dudek
Dariusz
D
Second Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland. mcdudek@cyf-kr.edu.pl
Legutko
Jacek
J
Heba
Grzegorz
G
Bartus
Stanislaw
S
Partyka
Lukasz
L
Huk
Ihor
I
Dembinska-Kiec
Aldona
A
Kaluza
Grzegorz L
GL
Dubiel
Jacek S
JS
D015906:Angioplasty, Balloon, Coronary; D001120:Arginine / Q000097:blood / Q000627:therapeutic use*; D017023:Coronary Angiography; D003327:Coronary Disease / Q000628:therapy; D023903:Coronary Restenosis / Q000517:prevention & control*; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000187:drug effects / Q000473:pathology*; D004311:Double-Blind Method; D006801:Humans; D006965:Hyperplasia / Q000517:prevention & control; D008297:Male; D011446:Prospective Studies; D015607:Stents; D017539:Tunica Intima / Q000187:drug effects* / Q000254:growth & development / Q000473:pathology; D018084:Ultrasonography, Interventional
D001120:Arginine