LETTER
Patient Care after Percutaneous Coronary Artery Interventions
Iyad Rashdan, MD
1 April 1998 | Volume 128 Issue 7 | Page 598
TO THE EDITOR:
In their excellent review [1], O'Meara and Dehmer mention that many drugs have been used to inhibit restenosis but that favorable effects were found only in some small studies and no large randomized trial has identified an effective drug. However, a large randomized, well-designed study [2] showed that treatment with probucol substantially reduces luminal narrowing after balloon coronary angioplasty.
In this study of 317 patients, 500 mg of probucol was given twice daily for 4 weeks before and 6 months after angioplasty. The restenosis rate (as defined by quantitative coronary angiography) was 38.9% in the placebo group and 20.7% in the probucol group (P = 0.003); the rate of repeated angioplasty was 26.6% in the placebo group and 11.2% in the probucol group (P = 0.009). These results are similar to the restenosis rate obtained with coronary artery stenting [3, 4].
Probucol is a cholesterol-lowering drug that has potent antioxidant properties. The mechanism by which probucol reduces the restenosis rate is not entirely clear. Although the drug's antioxidant properties were thought to be important, a different mixture of less potent antioxidants (ß-carotene, vitamin C, and vitamin E) did not reduce rates of restenosis or repeated angioplasty in the same study. On the other hand, probucol reduced both low- and high-density lipoprotein cholesterol levels, an effect that may offset its beneficial effect as a lipid-lowering agent.
To date, probucol is the only pharmacologic agent conclusively shown to prevent coronary restenosis after balloon angioplasty.
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Author and Article Information
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University of Oklahoma Health Sciences Center; Oklahoma City, OK 73104
1. O'Meara JJ, Dehmer GJ. Care of the patient and management of complications after percutaneous coronary artery interventions. Ann Intern Med. 1997; 127:458-71.
2. Tardif JC, Cote G, Lesperance J, Bourassa M, Lambert J, Doucet S, et al. Probucol and multivitamins in the prevention of restenosis after coronary angioplasty. Multivitamins and Probucol Study Group. N Engl J Med. 1997; 337:365-72.
3. Serruys PW, de Jaegere P, Kiemeneij F, Macaya C, Rutsch W, Heyndrickx G, et al. A comparison of balloon-expandable-stent implantation with balloon angioplasty in patients with coronary artery disease. Benestent Study Group. N Engl J Med. 1994; 331:489-95.
4. Fischman DL, Leon MB, Baim DS, Schatz RA, Savage MP, Penn I, et al. A randomized comparison of coronary-stent placement and balloon angioplasty in the treatment of coronary artery disease. Stent Restenosis Study Investigators. N Engl J Med. 1994; 331:496-501.
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