Effects of angiotensin-converting enzyme inhibitors or an angiotensin receptor blocker in combination with aspirin and cilostazol on in-stent restenosis.
It remains to be determined whether adding an angiotensin-converting enzyme inhibitor (ACEI) or an angiotensin II receptor blocker (ARB) to antiplatelet therapy has a therapeutic benefit on in-stent restenosis. After successful coronary stenting, 165 patients (167 lesions) were randomly assigned to a basal (aspirin 162 mg + cilostazol 200 mg/day), ACEI (basal treatment + quinapril 10 mg or perindopril 4 mg/day), or ARB (basal treatment + losartan 50 mg/day) treatment group. Quantitative coronary angiography was performed before, immediately following, and 6 months after stenting. Follow-up coronary angiography was completed in 126 patients (128 lesions). Restenosis rates tended to be higher (12, 26, and 12% for the basal, ACEI, and ARB groups, respectively), and target lesion revascularization rates were higher in the ACEI group than in the other groups (9, 23,* and 5%, respectively, *P < 0.05 versus basal group). Moreover, late lumen loss was higher in the ACEI group than in the basal group (0.60 +/- 0.55, 0.98 +/- 0.61* and 0.73 +/- 0.64 mm in the basal, ACEI, and ARB groups, respectively). The combinations of an ACEI or ARB with aspirin and cilostazol are ineffective for the prevention of in-stent restenosis, and an ACEI may even promote intimal proliferation after stent implantation.
Ujiie
Yuichi
Y
First Department of Internal Medicine, Fukushima Medical University, Japan.
Hirosaka
Akira
A
Mitsugi
Minoru
M
Ohwada
Takayuki
T
Igarashi
Morio
M
Kijima
Mikihiro
M
Komatsu
Nobuo
N
Hisa
Shinichi
S
Abe
Yukihiko
Y
Tsuda
Tatsunori
T
Yaoita
Hiroyuki
H
Maehara
Kazuhira
K
Maruyama
Yukio
Y
D000368:Aged; D000369:Aged, 80 and over; D047228:Angiotensin II Type 1 Receptor Blockers / Q000008:administration & dosage; D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage*; D001241:Aspirin / Q000008:administration & dosage*; D000077407:Cilostazol; D003324:Coronary Artery Disease / Q000628:therapy; D023903:Coronary Restenosis / Q000188:drug therapy* / Q000517:prevention & control*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020913:Perindopril / Q000008:administration & dosage; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage*; D000077583:Quinapril; D015607:Stents; D044005:Tetrahydroisoquinolines / Q000008:administration & dosage; D013777:Tetrazoles / Q000008:administration & dosage*
D047228:Angiotensin II Type 1 Receptor Blockers; D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D010975:Platelet Aggregation Inhibitors; D044005:Tetrahydroisoquinolines; D013777:Tetrazoles; D000077407:Cilostazol; D001241:Aspirin; D000077583:Quinapril; D020913:Perindopril