A COMPARATIVE STUDY ON EFFICACY OF ANGIOTENSIN RECEPTOR BLOCKER IN ACUTE CORONARY SYNDROME PATIENTS FOLLOWING MEDICATED AND NON-MEDICATED STENT IMPLANTATION

Abstract

Restenosis occurs in 15–50% patients within 6–9 months of post Percutaneous Coronary Interventions (PCI). Restenosis development is attributed to Angiotensin II through several physiologic mechanisms, which controls the renin-angiotensin system can be a focus for restenosis prevention. The objective of the present study was to assess the comparative clinical efficacy and safety parameters after PCI along with Angiotensin receptor blocker (ARBs) viz Telmisartan, Losartan and Valsartan following Bare Metal Stent (BMS) and Drug Eluting Stent (DES), followed by the determination of the incidence of In Stent Restenosis (ISR). The study retrospectively analyzed 252 patients, who underwent either BMS or DES between Dec-2007 to May-2009. Patients in both the groups (n=122 for BMS and n=130 for DES) were on continuous oral ARBs therapy either with Telmisartan (20-80 mg), Losartan (25-50 mg) or Valsartan (40-160 mg). The time frame of follow-up was at least 6 months after PCI.  The ISR rate in Losartan, Telmisartan and Valsartan group was observed to be 9 % (n=78), 16% (n=85) and 26% (n=89) respectively with no major reported adverse events in any of the groups. Test for significance found to risk factors of hypertension, diabetes, smoking, tobacco, alcohol was found to be influencing outcome significantly. Moreover, percent diameter stenosis (% DS) at follow-up in Losartan group was  significantly smaller than Telmisartan and Valsartan group (86.428 ± 10.293% Vs 77.500 ± 25.476% Vs 90.136 ± 10.661%, p= 0.0005) on comparison with total number of patient in each group respectively. Restenosis rate was found to be lowest in losartan group. On comparing restenosis rate among ARBs treated arms of BMS and DES, DES has lower restenosis prevalence. Risk factors like hypertension, diabetes, tobacco, smoking, alcohol influenced restenosis rate significantly.