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

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Korean Circulation Journal

Korean Circulation Journal 2004; 34(1): 35-40.

Published online: 31 January 2004

DOI: https://doi.org/10.4070/kcj.2004.34.1.35

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

Kwang Soo Cha, Moo Hyun Kim, Jin Woo Kim, Doo Il Kim, Hje Jin Kim, Young Dae Kim, Dong Soo Kim, Jong Seong Kim

Department of Cardiology, Dong-A University Hospital, Busan, Korea.

Department of Cardiology, Ulsan University Hospital, Ulsan, Korea.

Department of Cardiology, Pusan Paik Hospital, Busan, Korea.

kwangsoo@damc.or.kr

Copyright © 2004 The Korean Society of Circulation

Abstract

BACKGROUND: Carvedilol is a direct inhibitor of vascular smooth muscle cell migration and proliferation through inhibition of mitogen-activated protein kinase activity and regulation of cell cycle progression. It produced an 84% suppression of neointimal hyperplasia in rat carotid angioplasty model, but no data are available regarding its effect on stent restenosis in patients. We tested whether a sustained oral administration of carvedilol reduces restenosis after coronary stenting in patients.
METHODS: One hundred fifty nine patients were randomized to receive either carvedilol (50 mg/day, n=80) or atenolol (50 mg/day, n=79) at least 1 day before stenting and continued on the same medication over 3 months. The primary end point was angiographic restenosis (>50% diameter stenosis) at follow-up angiography.
RESULTS: Baseline clinical and angiographic variables were similar between the carvedilol and atenolol group. The carvedilol dose was tolerable in most patients after adjustment of other medications, but reduced in 3 patients due to hypotension and dizziness. Angiographic follow-up was done in 137 patients (86%) and the restenosis rate was not different significantly between both groups (17.1% versus 19.4%, p=0.732).
CONCLUSION: A sustained oral administration of carvedilol is not effective to reduce stent restenosis. With carvedilol targeting regulators of cell cycle progression and having a profound neointimal inhibition with a high blood concentration in an experiment, further investigations using a stent-based delivery to achieve a high local concentration may be warranted.

Keywords: Carvedilol, Stents, Coronary restenosis, Drug therapy

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