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 (23% vs 9%, P<0.05).
RCT (n=165)
Does adding an ACE inhibitor or ARB to aspirin and cilostazol reduce in-stent restenosis in patients undergoing coronary stenting?
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.
Absolute Event Rate: 23% vs 9%
p-value: p=<0.05
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 et al. (Sun,) conducted a 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 (23% vs 9%, P<0.05).