The effects of angiotensin receptor blockers on restonosis in patients with undergoing elective percutaneous coronary revascularization

8. ) SUMMARY : OBJECTIVE : We aimed to find the effects of losartan, an angiotensin receptor blocker ( ARB ), on restenosis of perfectly coronary revascularized patients by percutaneous coronary intervention ( PCI ). Percutaneous coronary revascularization procedures are used more commanly for the treatment of critical lesions in the major epicarcüal coronary arteries. Acute occlusions and especially development of restenosis are the most important disadventages of PCIs. Restenosis rate is thought to occur between 25 - 50 % though recent positive advances are going on. Recent studies with systemic drugs to prevent restenosis was found to be unsuccesfuLA II has arterogenic and endothelial functional effects with AT 1 receptors. In this study, we tested if A II receptor antagonism has benificial effects on restenosis with losartan. METHODS AND FİNDİNGS : Seventyfive patients ( pts ) ( 18 female, 57 male ) were included in this study. Fourtyeight of pts ( 13 F / 35 M )were given losartan 50 mg / day for 6 months ( Group 1 ), 27 of pts ( 5 F / 22 M ) were in control group ( Group 2 ). Control coronary angiography was performed at 4.8 months in Group 1, at 4.9 months in Group 2. Quntitative coronary angiography ( QCA ) was performed to all pts. Clinical, angiographic lesion and procedural characteristics and procedural and follow-up results were similar between two groups. In the control angiography, mimimal luminal diameter ( MLD ) was 1.79 ± 0.93 mm in Group 1, 1.63 ± 1.13 mm in Group 2 ( p = 0.354 ). Late luminal loss 0.86 ± 0.73 mm in Group 1, 1.01 ± 0.78 mm in Group 2 ( p = 0.612 ). Clinical restenosis rate was % 27 ( 13 / 48 pts ) in Gruop 1 and % 26 ( 7 / 27 pts ) in Group 2. Angiographic restenosis rate in all interventional procedures ( PTCA + Stent ) was % 33 ( 15 / 48 pts ) in Group 1, % 41 ( 1 1 / 27 pts ) in Group 2 ( p = 0.307 ). Angiographic in-stent restenosis rate % 27 ( 1 1 / 41 pts ) in Gruop 1, % 36 ( 8 / 22 pts ) in Group 2 ( p = 0.267 ). This study demostrated that losartan decreases restenosis rate in all interventional procedures by % 8 and in-stent restenosis rate by % 9 but this was not statistically significant. RESULTS : This study is the first clinical and angiographic trial that performed with losartan. Although losartan has no positive effect on clinical restenosis rate, it decreases the angiographic restenosis rate in the 41PCIs but this is not statistically significant. More studies with different ARBs and with different doses are needed to have more precise conclusions. KEY WORDS : Angiotensin receptor blocker, restenosis, percutaneous coronary revascularization. 42