Effects of Angiotensin-Converting Enzyme Inhibitors or an Angiotensin Receptor Blocker in Combination With Aspirin and Cilostazol on In-stent Restenosis

• Published in: International Heart Journal Vol. 47; no. 2; pp. 173 - 184
• Main Authors: Ujiie, Yuichi, Hirosaka, Akira, Mitsugi, Minoru, Ohwada, Takayuki, Igarashi, Morio, Kijima, Mikihiro, Komatsu, Nobuo, Hisa, Shinichi, Abe, Yukihiko, Tsuda, Tatsunori, Yaoita, Hiroyuki, Maehara, Kazuhira, Maruyama, Yukio
• Format: Journal Article
• Language: English
• Published: Japan International Heart Journal Association 01-03-2006
• Subjects: Aged; Aged, 80 and over; Angiotensin II receptor blocker; Angiotensin II Type 1 Receptor Blockers - administration & dosage; Angiotensin Receptor Antagonists; Angiotensin-converting enzyme inhibitor; Angiotensin-Converting Enzyme Inhibitors - administration & dosage; Aspirin - administration & dosage; Cilostazol; Coronary Artery Disease - therapy; Coronary Restenosis - drug therapy; Coronary Restenosis - prevention & control; Drug Therapy, Combination; Female; Humans; Male; Middle Aged; Perindopril - administration & dosage; Platelet Aggregation Inhibitors - administration & dosage; Restenosis; Stent; Stents; Tetrahydroisoquinolines - administration & dosage; Tetrazoles - administration & dosage
• ISSN: 1349-2365; 1349-3299
• DOI: 10.1536/ihj.47.173

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.