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CLINICAL STUDIES

n-3 fatty acids do not prevent restenosis after coronary angioplasty: results from the CART study

Odd Johansen, MD^*, Magne Brekke, MD, Ingebjørg Seljeflot, PhD, Michael Abdelnoor, MPH, PhD and Harald Arnesen, MD, PhD^*

^* Department of Cardiology, Ullevaal University Hospital, Oslo, Norway
Cardiovascular Radiology, Ullevaal University Hospital, Oslo, Norway
Research Forum, Ullevaal University Hospital, Oslo, Norway

Manuscript received July 14, 1998; revised manuscript received November 10, 1998, accepted January 20, 1999.

Reprint requests and correspondence: Dr. Odd Johansen, Department of Cardiology, Ullevaal University Hospital, N-0407 OSLO, Norway
odd.johansen{at}ioks.uio.no

OBJECTIVES

The aim of the study was to investigate whether omega-3 fatty acids (n-3 FA) reduce the occurrence of restenosis after percutaneous transluminal coronary angioplasty.

BACKGROUND

Meta-analyses have shown significant reduction of restenosis after coronary angioplasty upon supplementation with n-3 FA.

METHODS

In a prospective, placebo-controlled, double-blind study, 500 patients were randomly allocated to treatment with n-3 FA (Omacor^TM, Pronova AS, Oslo, Norway) 5.1 g/day or corn oil (placebo) starting at least two weeks prior to elective coronary angioplasty. The treatment was continued until restenosis evaluation by quantitative coronary angiography after six months. Stenosis was defined as a minimal luminal diameter (MLD) <40% of the reference diameter. Successful coronary angioplasty was defined as 20% acute gain in MLD and a residual stenosis <50%. Restenosis was defined as 20% late loss of diameter and stenosis >50% or an increase in stenosis of 0.7 mm. Three-hundred ninety-two patients fulfilled the criteria for initial stenosis and successful coronary angioplasty, and, except four patients who died, none were lost for follow-up.

RESULTS

Restenosis occurred in 108/266 (40.6%) of the treated stenoses in the Omacor group and in 93/263 (35.4%) in the placebo group (odds ratio [OR] 1.25, 95% confidence interval [CI] [0.87–1.80] p = 0.21). In the Omacor group one or more restenoses occurred in 90/196 (45.9%) patients as compared with 86/192 (44.8%) in the placebo group (OR 1.05, 95% CI [0.69–1.59] p = 0.82).

CONCLUSIONS

Supplementation with 5.1 g n-3 FA/day for six months, initiated at least two weeks prior to coronary angioplasty did not reduce the incidence of restenosis.

Abbreviations and Acronyms   CI = confidence interval   CART = Coronary Angioplasty Restenosis Trial   DHA = docosahexaenoic acid   EPA = eicosapentaenoic acid   EMPAR = Enoxaparin MaxEPA Prevention of Angioplasty Restenosis   MLD = minimal luminal diameter   NYHA = New York Heart Association   OR = odds ratio   n-3 FA = omega-3 fatty acids

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