Key result
Adding an ACEI or ARB to aspirin and cilostazol did not prevent in-stent restenosis; ACEI therapy increased target lesion revascularization compared to basal therapy.
Why the study?
Does adding an ACE inhibitor or ARB to aspirin and cilostazol reduce in-stent restenosis in patients undergoing coronary stenting?
RCT (n=165)
Does adding an ACE inhibitor or ARB to aspirin and cilostazol reduce in-stent restenosis in patients undergoing coronary stenting?
Answers are grounded in this paper and cite their sources.
Adding an ACE inhibitor or ARB to aspirin and cilostazol does not prevent in-stent restenosis, and ACE inhibitors may actually increase target lesion revascularization and late lumen loss.
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.
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Ujiie et al. (2006) conducted an RCT in In-stent restenosis (n=165). ACEI (quinapril or perindopril) or ARB (losartan) vs. Basal therapy (aspirin 162 mg + cilostazol 200 mg/day) was evaluated on Target lesion revascularization (p=<0.05). Adding an ACEI or ARB to aspirin and cilostazol did not prevent in-stent restenosis; ACEI therapy increased target lesion revascularization compared to basal therapy.
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