Department of Cardiology, Hirosaki University School of Medicine, Zaifu-cho 5, Hirosaki, 036-8562, Japan.
Int J Cardiol. 2009 Feb 6;132(1):114-20. doi: 10.1016/j.ijcard.2007.11.003. Epub 2008 Jan 10.
To determine whether telmisartan reduces in-stent restenosis (ISR) after coronary angioplasty using bare metal stent (BMS) in patients with acute myocardial infarction (AMI) compared with an angiotensin converting enzyme (ACE) inhibitor.
The efficacy of inhibition of renin-angiotensin-aldosterone system in patients with AMI has been established, and the prescription of ACE inhibitor is recommended as class I indication for all AMI patients, whereas that of angiotensin II receptor blocker (ARB) as class IIa. Telmisartan is a unique ARB since it has a peroxisome proliferator-activated receptor (PPAR) gamma activating effect which is known to reduce neointimal tissue proliferation after coronary stenting.
In 64 patients, telmisartan (20-40 mg per day) was orally administered for 6 months after stenting (telmisartan group). The incidence of ISR after stenting in these patients was retrospectively compared with those in the other 60 patients administrated enalapril (2.5-5 mg per day) (enalapril group).
There were no adverse events such as death, re-infarction and emergency bypass surgery in telmisartan group during a follow-up period for 6 months. The ISR rate was lower in telmisartan group (18.8%) than in enalapril group (33.3%) (p=0.06). However, percent diameter stenosis (%DS) at follow-up in telmisartan group was significantly smaller than in enalapril group (26.7+/-18.6% vs 38.0+/-23.9%, p=0.004). Late lumen loss was also significantly smaller in telmisartan group than in enalapril group (0.97+/-0.48 mm vs 1.19+/-0.68 mm, p=0.039).
Telmisartan not only is tolerable in patients with AMI but has a potential to reduce neointimal tissue proliferation after AMI treated with coronary angioplasty using BMS compared with enalapril.
比较替米沙坦与血管紧张素转换酶（ACE）抑制剂在急性心肌梗死（AMI）患者中使用裸金属支架（BMS）进行经皮冠状动脉成形术后的支架内再狭窄（ISR）发生率，以确定替米沙坦是否能降低 ISR。
肾素-血管紧张素-醛固酮系统抑制在 AMI 患者中的疗效已得到证实，ACE 抑制剂的处方被推荐为所有 AMI 患者的 I 类适应证，而血管紧张素 II 受体阻滞剂（ARB）则为 IIa 类。替米沙坦是一种独特的 ARB，因为它具有过氧化物酶体增殖物激活受体（PPAR）γ激活作用，已知可减少冠状动脉支架置入后新生内膜组织的增殖。
在 64 例患者中，在支架置入后（替米沙坦组）口服替米沙坦（每天 20-40 毫克）6 个月。回顾性比较这些患者与另外 60 例接受依那普利（每天 2.5-5 毫克）治疗的患者（依那普利组）支架置入后的 ISR 发生率。
替米沙坦组在 6 个月的随访期间无死亡、再梗死和急诊旁路手术等不良事件。替米沙坦组的 ISR 发生率（18.8%）低于依那普利组（33.3%）（p=0.06）。然而，替米沙坦组的随访时的直径狭窄率（%DS）显著小于依那普利组（26.7+/-18.6%比 38.0+/-23.9%，p=0.004）。替米沙坦组的晚期管腔丢失也显著小于依那普利组（0.97+/-0.48 毫米比 1.19+/-0.68 毫米，p=0.039）。
替米沙坦不仅在 AMI 患者中耐受良好，而且与依那普利相比，在 AMI 患者中使用 BMS 进行经皮冠状动脉成形术后具有降低新生内膜组织增殖的潜力。
