Clinical data: AVERT and QUO VADIS

Various clinical studies have been undertaken to assess whether medical interventions are effective for the prevention of cardiovascular events in patients with coronary artery disease. In the Angioplasty Compared with MEdical therapy (ACME) and Randomized Intervention Treatment of Angina 2 (RITA-2) studies, a medical strategy was associated with significantly fewer adverse cardiovascular events, but percutaneous revascularization was associated with greater functional improvement. In the Atorvastatin VErsus Revascularization Treatment (AVERT) study, aggressive lipid-lowering therapy with atorvastatin was more effective than angioplasty at reducing the total number of ischemic events; however, angioplasty was superior in terms of functional improvements. Thus, to prevent ischemic events in this population, coronary artery disease is best treated systemically; if better symptom control is required, angioplasty is still necessary. In the effects of QUinapril On Vascular ACE and Determinants of ISchemia (QUO VADIS) study, treatment with the angiotensin-converting enzyme (ACE) inhibitor quinapril was associated with significantly fewer ischemic events than placebo at one year following coronary artery bypass graft surgery. However, no significant differences were found between treatments in terms of primary and other secondary outcomes. For patients who have undergone bypass surgery, long term ACE inhibitor therapy may be of benefit, although further studies are warranted.