Angiotensin-converting enzyme inhibition as antiatherosclerotic therapy: No answer yet

Angiotensin-converting enzyme inhibitors have proven to be of clinical bene fit in congestive heart failure. Whether they also provide benefit to patie nts with coronary artery disease in the absence of congestive heart failure via an antiatherosclerotic mechanism is a question the QUinapril Ischemic Event Trial quantitative coronary angiography (QCA) study attempted to answ er: 1,750 patients with normal left ventricular function who were undergoin g coronary angiography and angioplasty were randomized to 20 mg/day of quin april versus placebo and followed far 3 years for cardiac end points. A ran domly selected subgroup of the total cohort underwent follow-vp angiography , The primary QCA end point was the categorical designation of progression versus nonprogression, defined either by QCA or by a cardiac event in patie nts selected for the QCA trial who had no usable follow-up x-ray film. Seco ndary end points in patients with 2 angiograms were: new stenosis developme nt, change in minimum lumen diameter index, and change in percent diameter stenosis index. There were 119 progressors among 243 placebo-treated patien ts (49%) and 111 progressors among 234 quinapril-treated patients (47%) (p = NS), There were 44 patients with new stenosis developement in the placebo group (19%) and 50 (22%) in the quinapril group (p = NS). Change in minimu m lumen diameter index was -0.21 +/- 0.03 mm in the placebo group and -0.18 +/- 0.03 mm in the quinapril group (p = NS), Finally, change in percent di ameter stenosis index was +5.1 +/- 1.0 in the placebo group and +3.5 +/- 1. 0 in the quinapril group (p = NS), potential confounders of this trial are presented and discussed. (C)1999 by Excerpta Medica, Inc.