title: Impact of telmisartan on coronary stenting in patients with acute myocardial infarction compared with enalapril.
abstract: OBJECTIVE
  To determine whether telmisartan reduces in-stent restenosis (ISR) after coronary angioplasty using bare metal stent (BMS) in patients with acute myocardial infarction (AMI) compared with an angiotensin converting enzyme (ACE) inhibitor.
  
  
  BACKGROUND
  The efficacy of inhibition of renin-angiotensin-aldosterone system in patients with AMI has been established, and the prescription of ACE inhibitor is recommended as class I indication for all AMI patients, whereas that of angiotensin II receptor blocker (ARB) as class IIa. Telmisartan is a unique ARB since it has a peroxisome proliferator-activated receptor (PPAR) gamma activating effect which is known to reduce neointimal tissue proliferation after coronary stenting.
  
  
  METHODS
  In 64 patients, telmisartan (20-40 mg per day) was orally administered for 6 months after stenting (telmisartan group). The incidence of ISR after stenting in these patients was retrospectively compared with those in the other 60 patients administrated enalapril (2.5-5 mg per day) (enalapril group).
  
  
  RESULTS
  There were no adverse events such as death, re-infarction and emergency bypass surgery in telmisartan group during a follow-up period for 6 months. The ISR rate was lower in telmisartan group (18.8%) than in enalapril group (33.3%) (p=0.06). However, percent diameter stenosis (%DS) at follow-up in telmisartan group was significantly smaller than in enalapril group (26.7+/-18.6% vs 38.0+/-23.9%, p=0.004). Late lumen loss was also significantly smaller in telmisartan group than in enalapril group (0.97+/-0.48 mm vs 1.19+/-0.68 mm, p=0.039).
  
  
  CONCLUSIONS
  Telmisartan not only is tolerable in patients with AMI but has a potential to reduce neointimal tissue proliferation after AMI treated with coronary angioplasty using BMS compared with enalapril.
authors.affiliation: Department of Cardiology, Hirosaki University School of Medicine, Zaifu-cho 5, Hirosaki, 036-8562, Japan.
authors.forename: Jin
authors.initials: J
authors.lastname: Yokoyama
authors.forename: Takumi
authors.initials: T
authors.lastname: Higuma
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Tomita
authors.forename: Naoki
authors.initials: N
authors.lastname: Abe
authors.forename: Koichi
authors.initials: K
authors.lastname: Oikawa
authors.forename: Takayuki
authors.initials: T
authors.lastname: Fujiwara
authors.forename: Takashi
authors.initials: T
authors.lastname: Yokota
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Yokoyama
authors.forename: Masaomi
authors.initials: M
authors.lastname: Kimura
authors.forename: Shingo
authors.initials: S
authors.lastname: Sasaki
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Hanada
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Osanai
authors.forename: Ken
authors.initials: K
authors.lastname: Okumura
mesh_terms: D015906:Angioplasty, Balloon, Coronary; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D001562:Benzimidazoles / Q000627:therapeutic use*; D001565:Benzoates / Q000627:therapeutic use*; D023903:Coronary Restenosis / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D004656:Enalapril / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000453:epidemiology / Q000628:therapy; D012189:Retrospective Studies; D015607:Stents; D000077333:Telmisartan
chemical_list: D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D001562:Benzimidazoles; D001565:Benzoates; D004656:Enalapril; D000077333:Telmisartan