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      Metoprolol Treatment to Prevent Restenosis following Percutaneous Transluminal Coronary Angioplasty


      , , ,


      S. Karger AG

      Restenosis, Beta-blockers, Metoprolol

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          This study tested the hypothesis that metoprolol reduces the restenosis rate after percutaneous transluminal coronary angioplasty (PTCA) in native coronary arteries as compared to placebo. Apart from prognostic clinical effects in the treatment of patients with coronary heart disease, several in vivo and ex vivo studies have demonstrated antiproliferative and antiatherogenic effects of beta-blockers. In the present study, 192 male patients were randomized in a double-blind fashion to metoprolol sustained-release treatment or placebo starting at least 1 day before angioplasty. Lesion diameters and restenosis rates were evaluated using automatic edge detection systems. The study endpoint was the angiographic restenosis rate 4 months after PTCA. Ninety-seven randomized patients had a control angiography a mean of 4.5 months after PTCA. Dropouts were evenly distributed between the metoprolol and placebo groups. Lumen loss in the target lesion was 0.36 mm in the metoprolol group and 0.32 mm in the placebo group. Restenosis rates averaged 57.5% in the metoprolol group and 44.2% in the placebo group using conventional restenosis criteria. Taking metoprolol serum levels above 50 mmol/l as an indication of definite compliance with the metoprolol treatment, the restenosis rate was 58.3%. In conclusion, 95 mg of sustained-release metoprolol failed to reduce the restenosis rate following angioplasty in native coronary arteries.

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          Most cited references 3

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          Coronary angioplasty with or without stent implantation for acute myocardial infarction. Stent Primary Angioplasty in Myocardial Infarction Study Group.

           O Madonna,  M Morice,  G Stone (1999)
          Coronary-stent implantation is frequently performed for treatment of acute myocardial infarction. However, few studies have compared stent implantation with primary angioplasty alone. We designed a multicenter study to compare primary angioplasty with angioplasty accompanied by implantation of a heparin-coated Palmaz-Schatz stent. Patients with acute myocardial infarction underwent emergency catheterization and angioplasty. Those with vessels suitable for stenting were randomly assigned to undergo angioplasty with stenting (452 patients) or angioplasty alone (448 patients). The mean (+/-SD) minimal luminal diameter was larger after stenting than after angioplasty alone (2.56+/-0.44 mm vs. 2.12+/-0.45 mm, P<0.001), although fewer patients assigned to stenting had grade 3 blood flow (according to the classification of the Thrombolysis in Myocardial Infarction trial) (89.4 percent, vs. 92.7 percent in the angioplasty group; P=0.10). After six months, fewer patients in the stent group than in the angioplasty group had angina (11.3 percent vs. 16.9 percent, P=0.02) or needed target-vessel revascularization because of ischemia (7.7 percent vs. 17.0 percent, P<0.001). In addition, the combined primary end point of death, reinfarction, disabling stroke, or target-vessel revascularization because of ischemia occurred in fewer patients in the stent group than in the angioplasty group (12.6 percent vs. 20.1 percent, P<0.01). The decrease in the combined end point was due entirely to the decreased need for target-vessel revascularization. The six-month mortality rates were 4.2 percent in the stent group and 2.7 percent in the angioplasty group (P=0.27). Angiographic follow-up at 6.5 months demonstrated a lower incidence of restenosis in the stent group than in the angioplasty group (20.3 percent vs. 33.5 percent, P<0.001). In patients with acute myocardial infarction, routine implantation of a stent has clinical benefits beyond those of primary coronary angioplasty alone.
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            Coronary-artery stenting compared with balloon angioplasty for restenosis after initial balloon angioplasty. Restenosis Stent Study Group.

             P Probst,  R Erbel,  M Haude (1998)
            Intracoronary stenting reduces the rate of restenosis after angioplasty in patients with new coronary lesions. We conducted a prospective, randomized, multicenter study to determine whether intracoronary stenting, as compared with standard balloon angioplasty, reduces the recurrence of luminal narrowing in restenotic lesions.
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              Effect of high dose angiotensin-converting enzyme inhibition on restenosis: Final results of the MARCATOR study, a multicenter, double-blind, placebo-controlled trial of cilazapril

               David Faxon (1995)

                Author and article information

                S. Karger AG
                April 2002
                25 April 2002
                : 97
                : 2
                : 94-98
                Klinik III für Innere Medizin, Universität zu Köln, Köln, Deutschland
                57679 Cardiology 2002;97:94–98
                © 2002 S. Karger AG, Basel

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                Page count
                Figures: 1, Tables: 4, References: 20, Pages: 5
                Cardiac Catheterization and Interventional Cardiology


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