European Heart Journal Advance Access originally published online on August 31, 2007
European Heart Journal 2007 28(19):2326-2331; doi:10.1093/eurheartj/ehm255
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Effect of perindopril on coronary remodelling: insights from a multicentre, randomized study
1 Department of Interventional Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands
2 Department of Cardiovascular Imaging, Otamendi Hospital, Azcuénaga 870, C1115AAB Buenos Aires, Argentina
Received 8 February 2007; revised 3 May 2007; accepted 18 May 2007; online publish-ahead-of-print 31 August 2007.
* Corresponding author. Tel/fax: +54 11 49648721. E-mail address: grodriguezgranillo{at}gmail.com
See page 2299 for the editorial comment on this article (doi:10.1093/eurheartj/ehm276)
Aims: This study sought to evaluate the effect of perindopril in coronary remodelling.
Methods and results: In this sub-study of a double-blind, multicentre trial, patients without clinical evidence of heart failure were randomized to perindopril 8 mg/day or placebo for at least 3 years and IVUS investigation was performed at both time-points. Positive and negative remodelling were defined as a relative increase (positive remodelling) or decrease (negative remodelling) of the mean vessel cross-sectional area (CSA) > 2 SD of the mean intra-observer difference. A total of 118 matched evaluable IVUS (711 matched 5 mm segments) were available at follow-up. After a median follow-up of 3.0 (inter-quartile range 1.9, 4.1) years, there was no significant difference in the change of plaque CSA between perindopril (360 segments) and placebo (351 segments) groups, P = 0.27. Conversely, the change in vessel CSA was significantly different between groups (perindopril –0.18 ± 2.4 mm2 vs. placebo 0.19 ± 2.4, P = 0.04). Negative remodelling occurred more frequently in the perindopril than in the placebo group (34 vs. 25%, P = 0.01). In addition, the placebo group showed a larger, although not significant, mean remodelling index (RI) than the perindopril group (1.03 ± 0.2 vs. 1.00 ± 0.2, P = 0.06). The temporal change in vessel dimensions assessed by the RI was significantly correlated with the change in plaque dimensions (r = 0.48, P < 0.0001).
Conclusion: In this sub-analysis of a multicentre, controlled study, long-term administration of perindopril was associated with a constrictive remodelling pattern without affecting the lumen.
Key Words: ACE-inhibitor • Progression • Remodelling • Atherosclerosis • Regression • EUROPA
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