Yamabe T, Imazu M, Yamamoto H, Ueda H, Hattori Y, Hayashi Y, Sekiguchi Y, Ito M, Yamakido M
Second Department of Internal Medicine, Hiroshima University School of Medicine, Japan.
Coron Artery Dis. 1995 Jul;6(7):573-9.
In experimental studies using cilazapril, the strongest inhibition of neointima formation was obtained when treatment was initiated 6 days before injury. The MERCATOR trial showed no reduction in restenosis with cilazapril given after percutaneous transluminal coronary angioplasty (PTCA). The purpose of this study is to determine whether previous administration of cilazapril could prevent restenosis.
A total of 167 patients were randomly and prospectively assigned to the cilazapril group or the control group. In the cilazapril group, 78 patients received a 2 mg dose of cilazparil daily, starting 7 days before PTCA and continuing for 6 months. Only 128 patients (cilazapril 56, control 72) completed the study because 39 dropped out. Coronary angiograms were evaluated by the quantitative coronary angiogram (QCA) system.
There were no differences between the two groups of patients with regard to baseline clinical and angiographic characteristics. QCA analysis (cilazapril 66 lesions, control 101 lesions): the loss at follow-up in minimal lumen diameter was 0.36 +/- 0.57 mm in the cilazapril group and 0.57 +/- 0.75 mm in the control group (P < 0.05). Restenosis rate: in the cilazapril group, 16 of 56 patients (28.6%) had restenosis in contrast to 36 of 72 patients (50.0%) in the control group (P < 0.02). When vessel restenosis was evaluated, 16 of 63 vessels (25.4%) demonstrated restenosis in the cilazapril group, in contrast to 41 of 82 vessels (50.0%) in the control group (P < 0.01).
Treatment using cilazapril 7 days before PTCA significantly reduced the rate of restenosis. These data suggest that previous administration of cilazapril might be important for preventing restenosis.
在使用西拉普利的实验研究中，在损伤前6天开始治疗时，对新生内膜形成的抑制作用最强。MERCATOR试验表明，经皮腔内冠状动脉成形术（PTCA）后给予西拉普利并不能降低再狭窄率。本研究的目的是确定预先给予西拉普利是否可以预防再狭窄。
总共167例患者被随机、前瞻性地分为西拉普利组或对照组。在西拉普利组中，78例患者从PTCA前7天开始每天服用2mg西拉普利，并持续6个月。只有128例患者（西拉普利组56例，对照组72例）完成了研究，因为有39例退出。通过定量冠状动脉造影（QCA）系统对冠状动脉造影进行评估。
两组患者在基线临床和血管造影特征方面没有差异。QCA分析（西拉普利组66处病变，对照组101处病变）：西拉普利组随访时最小管腔直径的损失为0.36±0.57mm，对照组为0.57±0.75mm（P<0.05）。再狭窄率：西拉普利组56例患者中有16例（28.6%）发生再狭窄，而对照组72例患者中有36例（50.0%）发生再狭窄（P<0.02）。当评估血管再狭窄时，西拉普利组63处血管中有16处（25.4%）出现再狭窄，而对照组82处血管中有41处（50.0%）出现再狭窄（P<0.01）。
PTCA前7天使用西拉普利治疗可显著降低再狭窄率。这些数据表明，预先给予西拉普利可能对预防再狭窄很重要。
