Pharmacogenetic analysis of the effect of angiotensin-converting enzyme inhibitor on restenosis after percutaneous transluminal coronary angioplasty

Angiotensin-converting enzyme (ACE) inhibitors are reported to prevent neoi ntimal formation after balloon injury in animal models, but in most prospec tive studies in humans, ACE inhibitors failed to prevent restenosis after p ercutaneous transluminal coronary angioplasty (PTCA). The ACE genotype assi gned by an insertion/deletion (I/D) polymorphism is known to affect the pot ency of ACE inhibitors in several renal diseases. The authors attempted to clarify whether the effect of ACE inhibitors on restenosis might be modifie d by the ACE genotype. A total of 126 patients was randomly and prospective ly assigned to the control group and the imidapril group. In the imidapril group, patients received 5 mg imidapril daily, starting 1 day before PTCA a nd continuing for 3 to 6 months. Forty-six control (65 vessels) and 32 imid april patients (43 vessels) completed the study. The minimal lumen diameter before and after the procedure did not differ significantly among the grou ps with the three genotypes (II, ID, and DD) in both the control and imidap ril groups. Late luminal loss during the follow-up period was not related t o the ACE genotype in the control group but was significantly related in th e imidapril group (II, 0.63 +/- 0.19 mm; ID + DD, 1.12 +/- 0.14 mm, p < 0.0 5). Furthermore, in the II genotype, imidapril significantly reduced late l oss and restenosis rate as defined by most of the frequently used definitio ns. In conclusion the ACE VD polymorphism may influence the effect of ACE i nhibitors in preventing restenosis after PTCA.