The Effectiveness of Carvedilol, a New Antioxidant and Antiproliferative Beta-Blocker, on Prevention of Restenosis after Coronary Stent Implantation：a Prospective, Randomized, Multicenter Study

다국어 초록 (Multilingual Abstract)

Background: Carvedilol is a direct inhibitor of vascular smooth muscle cell migration and proliferation throughinhibition of mitogen-activated protein kinase activity and regulation of cell cycle progression. It produced an84% suppression of neointimal hyperplasia in rat carotid angioplasty model, but no data are available regardingits effect on stent restenosis in patients. We tested whether a sustained oral administration of carvedilol reducesrestenosis after coronary stenting in patients. Methods: One hundred fifty nine patients were randomized to receiveeither carvedilol (50 mg/day, n=80) or atenolol (50 mg/day, n=79) at least 1 day before stenting and continuedon the same medication over 3 months. The primary end point was angiographic restenosis (>50% diameterstenosis) at follow-up angiography. Results: Baseline clinical and angiographic variables were similar betweenthe carvedilol and atenolol group. The carvedilol dose was tolerable in most patients after adjustment of othermedications, but reduced in 3 patients due to hypotension and dizziness. Angiographic follow-up was done in137 patients (86%) and the restenosis rate was not different significantly between both groups (17.1% versus19.4%, p=0.732). Conclusions: A sustained oral administration of carvedilol is not effective to reduce stentrestenosis. With carvedilol targeting regulators of cell cycle progression and having a profound neointimal inhibitionwith a high blood concentration in an experiment, further investigations using a stent-based delivery to achieve ahigh local concentration may be warranted. (Korean Circulation J 2004;34 (1):35-40)

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