培哚普利及缬沙坦预防冠状动脉支架内再狭窄

Perindopril and valsartan prevent in-stent restenosis

目的观察血管紧张素转化酶抑制药(angiotensin-converting enzyme inhibitor,ACEI)培哚普利和血管紧张素受体阻断药(angiotensin receptor blocker,ARB)缬沙坦预防冠状动脉支架植入术后支架内再狭窄的临床效果。方法将126例成功接受支架治疗的冠心病病人随机分为ACEI组64例和ARB组62例,通过冠状动脉造影以支架内或支架临近血管管腔直径狭窄程度等于或大于50%为再狭窄的诊断标准,随访6～12个月,记录主要不良心脏事件(包括死亡、心绞痛及非致死性心肌梗死)的发生率、靶血管再次形成率和支架内再狭窄发生率。结果两组病人的性别、年龄、既往疾病、超声心动图左心房直径和左心室内径、服用药物种类、血脂、操作因素、治疗时间差异无统计学意义(P>0.05)。ACEI组支架内再狭窄发生率(18.8%)高于ARB组支架内再狭窄发生率(4.8%),两组差异有统计学意义(P=0.03)。ACEI组和ARB组主要不良心脏事件发生率分别为6.3%和1.6%,但差异无统计学意义(P=0.36)。靶血管再次重建率ACEI组(15.6%)高于ARB组(3.2%),差异有统计学差异(P=0.04)。结论ARB可能比ACEI更有效预防冠状动脉支架内再狭窄。

Objectives To study the effects of angiotensin converting enzyme inhibitor （ACEI） and angiotensin receptor blocker （ARB） on prevention of in-stent restenosis in patients with coronary artery disease. Methods 126 patients who were successfully stented, were randomly divided into ACEI group （64 cases using perindopril） and ARB group （62 cases using valsartan）. The definition of in-stenosis was that the degree of stenosis diameter in stent or close to stent was more than 50% at angiography. All the patients were followed-up for 6-12 months with regard to the incidence of major adverse cardiovascular events （including death, angina pectoris and nonfatal myocardial infarction）, target vessel revascularization and restenosis. Results The difference of sex, age, past history, left atrial diameter and left ventricular thickenss measured with echocardiography, drug history, cholesterol, quantitative coronary angiography , operation effect in two groups had no statistical significance （P〉0.05）. ACEI group had a higher incidence in restenosis than that in the ARB group （18.8% vs 4.8%, P=0.03）. There were no significant difference between AECI group and ARB group in major adverse cardiovascular events （6.3% vs 1.6%, P=0.36）. The incidence of the target vessel revascularization was also higher in the ACEI group than that in the ARB group （15.6% vs3.2%）, the difference between them showed statistically significance（P=0.04）. Conclusions ARB may be more effective for the prevention of in-stent restenosis than ACEI.