Quinapril with high affinity to tissue angiotensin-converting enzyme reduces restenosis after percutaneous transcatheter coronary intervention

Experimental studies have demonstrated that vascular injury resulted in an induction of vascular angiotensin-converting enzyme (ACE), and have suggest ed that inhibition of vascular ACE might be important in the prevention of restenosis. The present study aimed to determine the effect of quinapril, a n ACE inhibitor with high affinity to tissue ACE, on restenosis following c oronary intervention. The design of this study was a prospective, randomize d, open, and non-placebo controlled trial. Patients with ischemic heart dis ease were enrolled after successful percutaneous transluminal coronary angi oplasty or stent implantation at 7 participating institutions. Two hundred and fifty-three patients with 294 lesions were randomly assigned to the qui napril (10-20 mg per day) group or control group. Administration of quinapr il was continued for 3-6 months of the follow-up. Quantitative coronary ang iography was performed before and after angioplasty and at follow-up. Core laboratory measurements were performed independently and blinded. Follow-up angiography was performed in 108 patients with 124 lesions in the quinapri l group and in 107 patients with 130 lesions in the control group. The base line characteristics and findings of angioplasty showed no significant diff erences between the two groups. However, in the quinapril group, restenosis per patient and per lesion was significantly lower (34.3% vs. 47.7%, p < 0 .05 and 30.6% vs. 43.8%, p < 0.05). Multivariable analysis revealed that ad ministration of quinapril independently contributed to reducing the resteno sis per patient and per lesion (odds ratio, 0.73; 95% confidence interval, 0.54-0.99 and odds ratio, 0.75; 95% confidence interval, 0.57-0.99). In con clusion, quinapril significantly reduces restenosis following coronary inte rvention.