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Evidence that angiotensin-converting enzyme inhibitor use diminishes the need for coronary revascularization after stenting

      Abstract

      Restenosis after stenting, in contrast to balloon angioplasty, is predominantly due to neointima formation. Angiotensin-converting enzyme (ACE) inhibitors diminish neointima formation in animal models of arterial injury. In an observational study, 1,598 patients who were treated from 1994 to 1997 with coronary stents and prospectively followed for clinical events were divided into 2 groups: those receiving ACE inhibitors at the time of stenting (n = 345) and those who did not (n = 1,253). Multivariate logistic regression was used to adjust for imbalances between populations with regard to elements relevant to risk of 12-month coronary revascularization, which was the primary study end point. After adjustment, ACE inhibitor usage remained significantly protective against revascularization (odds ratio [OR] 0.46, 95% confidence interval 0.29 to 0.73, p = 0.001). Protection was not observed in patients treated with balloon angioplasty alone during the same period (OR 1.06, p = 0.33), which is consistent with the results of prior randomized trials. ACE inhibitors appear to decrease late revascularization, possibly due to a reduction in restenosis after coronary stenting.
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      References

        • Hoffman R
        • Mintz G.S
        • Dussaillant G.R
        • Popma J.J
        • Pichard A.D
        • Satler L.F
        • Kent K.M
        • Griffin J
        • Leon M.B
        Patterns and mechanisms of in-stent restenosis.
        Circulation. 1996; 94: 1247-1254
        • Bell L
        • Madri J
        Influence of the angiotensin system on endothelial and smooth muscle cell migration.
        Am J Physiol. 1996; 137: 7-12
        • Pratt R.E
        • Dzau V.J
        Pharmacological strategies to prevent restenosis.
        Circulation. 1996; 93: 848-852
        • Campbell-Boswell M
        • Robertson Jr, A.L
        Effects of angiotensin II and vasopressin on human smooth muscle cells in vitro.
        Exp Mol Pathol. 1996; 35: 265-276
        • Daemen M.J.A.P
        • Lombardi D.M
        • Bosman F.T
        • Schwartz S.M
        Angiotensin II induces smooth muscle cell proliferation in the normal and injured rat arterial wall.
        Circ Res. 1996; 68: 450-456
        • Scott-Burden T
        • Hahn A
        • Resink T.J
        • Buhler F.R
        Modulation of extracellular matrix by angiotensin II.
        J Cardiovasc Pharmacol. 1996; 16: S36-S41
        • Powell J.S
        • Clozel J.-P
        • Muller R.K
        • Kuhn H
        • Hefti F
        • Hosang M
        • Baumgartner H.R
        Inhibitors of angiotensin-converting enzyme prevent myointimal proliferation after vascular injury.
        Science. 1996; 245: 186-188
        • Huber K.C
        • Schwartz R.S
        • Edwards W.D
        • Camrud A.R
        • Bailey K.R
        • Jorgenson M.A
        • Holmes Jr, D.R
        Effects of angiotensin converting enzyme inhibition on neointimal proliferation in a porcine coronary injury model.
        Am Heart J. 1996; 125: 695-701
        • Clozel J.P
        • Hess P
        • Michael C
        • Schietinger K
        • Baumgartner H.R
        Inhibition of converting enzyme and neointima formation after vascular injury in rabbits and guinea pigs.
        Hypertension. 1996; 18: I-155-I-159
        • Ribichini F
        • Steffenino G
        • Dellavalle A
        • Matullo G
        • Colajanni E
        • Camilla T
        • Vado A
        • Benetton G
        • Uslenghi E
        • Piazza A
        Plasma activity and insertion/deletion polymorphism of angiotensin I-converting enzyme.
        Circulation. 1996; 97: 147-154
      1. Does the new angiotensin converting enzyme inhibitor cilazapril prevent restenosis after percutaneous transluminal coronary angioplasty? Results of the MERCATOR study.
        Circulation. 1996; 86: 100-110
        • Faxon D.P
        • Multicenter European Research Trial with Cilazapril after Angioplasty to Prevent Transluminal Coronary Obstruction and Restenosis (MERCATOR) Study Group
        • the Multicenter American Research Trial with Cilazapril After Angioplasty to Prevent Transluminal Coronary Obstruction, and Restenosis (MARCATOR) Study Group
        Effect of high dose angiotensin-converting enzyme inhibition on restenosis.
        J Am Coll Cardiol. 1996; 25: 362-369
        • Rutherford J.D
        • Pfeffer M.A
        • Moyé L.A
        • Davis B.R
        • Flaker G.C
        • Kowey P.R
        • Lamas G.A
        • Miller H.S
        • Packer M
        • Roueau J.L
        • Braunwald E
        • Multicenter European Research Trial with Cilazapril after Angioplasty to Prevent Transluminal Coronary Obstruction and Restenosis (MERCATOR) Study Group
        Effects of captopril on ischemic events after myocardial infarction.
        Circulation. 1996; 90: 1731-1738
        • Jackson E.K
        • Garrison J.C
        Renin and angiotensin.
        in: Molinoff P.B Rudlon W Goodman & Gilman’s The Pharmacological Basis of Therapeutics. 9th ed. McGraw-Hill, New York1996: 744-746