Carvedilol for prevention of restenosis after directional coronary atherectomy - Final results of the European Carvedilol Atherectomy Restenosis (EUROCARE) trial

Background-in addition to its known properties as a competitive, nonselecti ve beta and alpha-1 receptor blocker, carvedilol directly inhibits vascular myocyte migration and proliferation and exerts antioxidant effects that ar e considerably greater than those of vitamin E or probucol. This provides t he basis for an evaluation of carvedilol for the prevention of coronary res tenosis. Methods and Results-In a prospective, double-blind, randomized, placebo-con trolled trial, 25 mg of carvedilol was given twice daily, starting 24 hours before scheduled directional coronary atherectomy and continuing fur 5 mon ths after a successful procedure. The primary end point was the minimal lum inal diameter as determined during follow-up angiography 26+/-2 weeks after the procedure. Of 406 randomized patients, 377 underwent attempted atherec tomy, and in 324 (88.9%), a less than or equal to 50% diameter stenosis was achieved without the use of a stent. Evaluable follow-up angiography was a vailable in 292 eligible patients (90%). No differences in minimal luminal diameter (1.99+/-0.73 mm versus 2.00+/-0.74 mm), angiographic restenosis ra te (23.4% versus 23.9%), target lesion revascularization (16.2 versus 14.5) , or event-free survival (79.2% versus 79.7%) between the placebo and carve dilol groups were observed at 7 months. Conclusions-The maximum recommended daily dose of the antioxidant and beta- blocker carvedilol failed to reduce restenosis after successful atherectomy . These findings are in contrast to those of the Multivitamins and Probucol Trial, which raises doubts regarding the validity of the interpretation th at restenosis reduction by probucol was via antioxidant effects. The relati onship between antioxidant agents and restenosis remains to be elucidated.