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Published on: May 14, 2013
Beneficial effects of valsartan on target lesion revascularization after percutaneous coronary interventions with
Takenori Okada1, Hideya Yamamoto, Tomokazu Okimoto
1Department of Cardiovascular Medicine, Hiroshima University, Graduate School of Biomedical Sciences, Hiroshima, Japan.
Insights
Valsartan did not significantly reduce major cardiovascular events after percutaneous coronary intervention (PCI). However, valsartan therapy showed a significant reduction in target lesion revascularization (TLR) in patients receiving bare-metal stents.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Angiotensin II receptor blockers (ARBs) are known to reduce cardiovascular events.
- The study investigated valsartan's effect on outcomes post-percutaneous coronary intervention (PCI) with bare-metal stents (BMS).
Purpose of the Study:
- To evaluate the efficacy of valsartan as an add-on therapy in patients undergoing PCI with BMS.
Main Methods:
- A prospective, randomized study involving 191 patients.
- Patients were assigned to either valsartan (40-80 mg) or non-ARB treatment.
- The primary endpoint was a composite of death, myocardial infarction, and target lesion revascularization (TLR) at 18 months.
Main Results:
- No significant difference was observed in the primary endpoint between the valsartan and non-ARB groups (18.9% vs. 24.8%).
- However, the valsartan group showed a statistically significant reduction in TLR at a median follow-up of 4.4 years (27.8% to 14.5%).
Conclusions:
- Valsartan treatment was not superior to non-ARB treatment for the primary endpoint at 18 months post-PCI.
- The observed reduction in TLR in the valsartan group requires further statistical validation with larger sample sizes.
Background:
Angiotensin II receptor blockers (ARB) have been shown to reduce cardiovascular events in patients at risk. The effect of valsartan on outcomes after percutaneous coronary interventions (PCI) with bare-metal stents (BMS) was investigated.
Methods And Results:
The prospective, randomized study included 191 patients at 5 participating institutions, who were randomly assigned to either a 40-80 mg valsartan add-on or non-ARB treatment. The primary endpoint was a composite of all-cause death, non-fatal myocardial infarction, and target lesion revascularization (TLR) at 18 months. Enrollment was stopped when the use of drug-eluting stents has been expanded in Japan. No significant differences existed between the groups in terms of primary endpoint (18.9% vs. 24.8%; hazard ratio [HR], 0.84; 95% confidence interval [CI], 0.61-1.14; P = 0.26). In the valsartan group, as compared with the non-ARB group, the secondary endpoint of TLR was significantly reduced at a median follow-up 4.4 years; the rate of TLR was from 27.8% to 14.5% (HR, 0.69; 95%CI, 0.49-0.96; P = 0.024).
Conclusions:
Valsartan treatment was not superior to non-ARB treatment in reducing the primary endpoint after PCI at 18 months. The pre-specified secondary endpoint of TLR was lower in the valsartan group, but this needs to be proved statistically with an adequate study sampling.
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