EFFECT OF CILAZAPRIL ON VASCULAR RESTENOSIS AFTER PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY

Background: In experimental studies using cilazapril, the strongest in hibition of neointima formation was obtained when treatment was initia ted 6 days before injury. The MERCATOR trial showed no reduction in re stenosis with cilazapril given after percutaneous transluminal coronar y angioplasty (PTCA). The purpose of this study is to determine whethe r previous administration of cilazapril could prevent restenosis. Meth ods: A total of 167 patients were randomly and prospectively assigned to the cilazapril group or the control group. In the cilazapril group, 78 patients received a 2 mg dose of cilazapril daily, starting 7 days before PTCA and continuing for 6 months. Only 128 patients (cilazapri l 56, control 72) completed the study because 39 dropped out. Coronary angiograms were evaluated by the quantitative coronary angiogram (QCA ) system. Results: There were no differences between the two groups of patients with regard to baseline clinical and angiographic characteri stics. QCA analysis (cilazapril 66 lesions, control 101 lesions): the loss at follow-up in minimal lumen diameter was 0.36 +/- 0.57 mm in th e cilazapril group and 0.57 +/- 0.75 mm in the control group (P < 0.05 ). Restenosis rate: in the cilazapril group, 16 of 56 patients (28.6%) had restenosis in contrast to 36 of 72 patients (50.0%) in the contro l group (P < 0.02). When vessel restenosis was evaluated, 16 of 63 ves sels (25.4%) demonstrated restenosis in the cilazapril group, in contr ast to 41 of 82 vessels (50.0%) in the control group (P < 0.01). Concl usions: Treatment using cilazapril 7 days before PTCA significantly re duced the rate of restenosis. These data suggest that previous adminis tration of cilazapril might be important for preventing restenosis.