キナプリルがPTCA後の再狭窄に及ぼす影響—降圧効果と損失係数の関係

Effect of Angiotensin-Converting Enzyme Inhibitor Quinapril on Restenosis after Percutaneous Transluminal Coronary Angioplasty : Correlation between the degree of decreased blood pressure and loss index

　組織ACEに高い親和性を持つキナプリルがPTCA後の再狭窄を予防できるか前向きに検討した．1996年4月から12月までの連続待機的PTCA症例において高血圧患者を対象とした．術後にコントロール群とキナプリル群に無作為に選定，キナプリル群には術後よりキナプリル20mg／日の投与を開始した．術前・後および3カ月後に定量的冠動脈解析を行った．対象となったコントロール群（n＝9）とキナプリル群（n＝11）の臨床的背景に差はなく，対照血管径，術前・後，3カ月の最小血管径および再狭窄率に差は認めなかった．キナプリル群では3カ月後における平均血圧の差と晩期損失径および損失係数との間に相関関係を認めた（p＝0.02,p＝0.04）．キナプリルが十分に作用する，すなわち大きな降圧効果が得られれば損失係数を抑えることができるため再狭窄を予防する可能性が示唆された．

Quinapril is an ACE inhibitor characterized by a short accumulation halflife and potent binding affinity for both plasma and tissue ACE. We investigated the effect of quinapril on restenosis after PTCA.

After successful PTCA, patients with hypertension were randomly assigned to the quinapril group and the control group. The quinapril group received 20mg of quinapril daily for 3 months.

Coronary angiograms before, after PTCA and at the time of follow-up three months afterwords were quanti-tatively analyzed.

There was no difference in the minimal luminal diam-eters after PTCA and at the time of follow-up between the control group (n=9) and the quinapril group (n=11).The angiographic restenosis rate was 36% in the quina-pril group and 44% in the control group (p=ns). At the time of follow up. the mean (±SD) systolic blood pres-sure was lower in the quinapril group than in the control group (145±11mmHg vs 133±10mmHg, p＜0.05) In the quinapril group, correlation was demonstrated between the degree of decreased blood pressure and late loss, loss index (p=0.02, p=0.04).