The Effectiveness of Carvedilol, a New Antioxidant and Antiproliferative Beta-Blocker, on Prevention of Restenosis after Coronary Stent Implantation: a Prospective, Randomized, Multicenter Study.
- Author:
Kwang Soo CHA
1
;
Moo Hyun KIM
;
Jin Woo KIM
;
Doo Il KIM
;
Hje Jin KIM
;
Young Dae KIM
;
Dong Soo KIM
;
Jong Seong KIM
Author Information
- Publication Type:Multicenter Study ; Original Article ; Randomized Controlled Trial
- Keywords: Carvedilol; Stents; Coronary restenosis; Drug therapy
- MeSH: Administration, Oral; Angiography; Angioplasty; Animals; Atenolol; Cell Cycle; Cell Movement; Coronary Restenosis; Dizziness; Drug Therapy; Follow-Up Studies; Humans; Hyperplasia; Hypotension; Muscle, Smooth, Vascular; Prospective Studies*; Protein Kinases; Rats; Stents*
- From:Korean Circulation Journal 2004;34(1):35-40
- CountryRepublic of Korea
- Language:English
- Abstract: BACKGROUND: Carvedilol is a direct inhibitor of vascular smooth muscle cell migration and proliferation through inhibition of mitogen-activated protein kinase activity and regulation of cell cycle progression. It produced an 84% suppression of neointimal hyperplasia in rat carotid angioplasty model, but no data are available regarding its effect on stent restenosis in patients. We tested whether a sustained oral administration of carvedilol reduces restenosis after coronary stenting in patients. METHODS: One hundred fifty nine patients were randomized to receive either carvedilol (50 mg/day, n=80) or atenolol (50 mg/day, n=79) at least 1 day before stenting and continued on the same medication over 3 months. The primary end point was angiographic restenosis (>50% diameter stenosis) at follow-up angiography. RESULTS: Baseline clinical and angiographic variables were similar between the carvedilol and atenolol group. The carvedilol dose was tolerable in most patients after adjustment of other medications, but reduced in 3 patients due to hypotension and dizziness. Angiographic follow-up was done in 137 patients (86%) and the restenosis rate was not different significantly between both groups (17.1% versus 19.4%, p=0.732). CONCLUSION: A sustained oral administration of carvedilol is not effective to reduce stent restenosis. With carvedilol targeting regulators of cell cycle progression and having a profound neointimal inhibition with a high blood concentration in an experiment, further investigations using a stent-based delivery to achieve a high local concentration may be warranted.
