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CLINICAL RESEARCH: INTERVENTIONAL CARDIOLOGY

Angiotensin I–converting enzyme (ACE) inhibitors and restenosis after coronary artery stenting in patients with the DD genotype of the ACE gene

^* Deutsches Herzzentrum München and 1. Medizinische Klinik rechts der Isar, Technische Universität München, Munich, Germany

Manuscript received July 25, 2002; revised manuscript received September 18, 2002, accepted September 26, 2002.

^* Reprint requests and correspondence: Dr. Werner Koch, Deutsches Herzzentrum München, Experimentelle Kardiologie, Lazarettstrasse 36, D-80636, Munich, Germany.
wkoch{at}dhm.mhn.de

OBJECTIVES: We tested the hypothesis that patients with the DD genotype of the angiotensin I–converting enzyme (ACE) gene who are treated with ACE inhibitors are at a higher risk of restenosis after coronary stent placement than patients who do not receive ACE inhibitors.

BACKGROUND: Two recent studies with a limited series of patients carrying the DD genotype suggested an unfavorable impact of the use of ACE inhibitors on the restenotic process after implantation of stents in coronary arteries. Because these findings may question the use of ACE inhibitors after coronary stenting, we examined this important issue in a large series of patients.

METHODS: We determined the ACE gene I/D genotype of 2,222 consecutive patients with symptomatic coronary artery disease who underwent stent implantation. The patients with the DD genotype (n = 612) constituted the study population. The primary end point was in-stent restenosis, which was assessed as angiographic restenosis (50% diameter stenosis at six-month follow-up) and clinical restenosis (need for target vessel revascularization due to symptoms or signs of ischemia in the presence of angiographic restenosis over one year after the intervention).

RESULTS: Of the 612 patients with the DD genotype, 403 (65.8%) were treated with ACE inhibitors and 209 (34.2%) did not receive ACE inhibitors. The angiographic and clinical restenosis rates were not significantly different between the group treated with ACE inhibitors and the group not receiving ACE inhibitors (p = 0.55). Continuous measures of restenosis, minimal lumen diameter, diameter stenosis, late lumen loss, and loss index were also similar in both groups (p 0.55). In addition, one-year survival free of myocardial infarction was not significantly different between the two groups (p = 0.27).

CONCLUSIONS: In contrast to previous reports, our study provides evidence that patients carrying the DD genotype are not exposed to an increased risk of restenosis after stent placement when treated with ACE inhibitors.

Abbreviations and Acronyms   ACE   angiotensin I–converting enzyme   MI   myocardial infarction   MLD   minimal lumen diameter   TVR   target vessel revascularization

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