Comparative Effectiveness of Angiotensin-Converting Enzyme Inhibitors and/or Angiotensin II Receptor Blockers Added to Standard Medical Therapy for Treating Patients With Stable Ischemic Heart Disease and Preserved Left Ventricular Systolic Function
Characteristics of Trials Evaluating the Addition of an ACEI or an ARB to Standard Medical Therapy (SMT) Versus SMT Alone Close to a Revascularization Procedure
This slide summarizes the seven trials that were evaluated in the Comparative Effectiveness Review (CER) to assess the benefits and harms of adding an angiotensin-converting enzyme inhibitor (ACEI) or an angiotensin II-receptor blocker (ARB) to standard medical therapy, as opposed to standard medical therapy alone, in patients with stable ischemic heart disease who are in close proximity to a revascularization procedure. The patient population in these trials ranged from small (n = 91) to moderate (n = 2,553) in size. Typically, ACEIs were administered within a week after a revascularization procedure (as listed in the slide); in one trial, an ARB was given within 7 to 14 days before coronary stenting. In many of these trials, these treatment modalities were chosen to assess their impact on restenosis after these revascularization procedures. For detailed information on these trials, refer to the original comparative effectiveness review available at: http://effectivehealthcare.ahrq.gov/index.cfm/search-for-guides-reviews-and-reports/?pageaction=displayproduct&productID=335.
- Agency for Healthcare Research and Quality. Methods Reference Guide for Effectiveness and Comparative Effectiveness Reviews, Version 1.0 [Draft posted Oct. 2007]. Rockville, MD.
- Faxon DP, for the Multicenter American Research Trial With Cilazapril After Angioplasty to Prevent Transluminal Coronary Obstruction and Restenosis (MARCATOR) Study Group. Effect of high dose angiotensin-converting enzyme inhibition on restenosis: final results of the MARCATOR study, a multicenter, double-blind, placebo-controlled trial of cilazapril. J Am Coll Cardiol 1995;25:362-9.
- Kjøller-Hansen L, Steffensen R, Grande P. The Angiotensin-converting Enzyme Inhibition Post Revascularization Study (APRES). J Am Coll Cardiol 2000;35:881-8.
- Kondo J, Sone T, Tsuboi H, et al. Effect of quinapril on intimal hyperplasia after coronary stenting as assessed by intravascular ultrasound. Am J Cardiol 2001;87:443- 5.
- Meurice T, Bauters C, Hermant X, et al. Effect of ACE inhibitors on angiographic restenosis after coronary stenting (PARIS): a randomized, double-blind, placebo-controlled trial. Lancet 2001;357:1321-4.
- Pitt B, O’Neill B, Feldman R, et al. The Quinapril Ischemic Event Trial (QUIET): evaluation of chronic ACE inhibitor therapy in patients with ischemic heart disease and preserved left ventricular function. Am J Cardiol 2001;87:1058-63.
- Radke PW, Figulla HR, Drexler H, et al, for the AACHEN Trial Investigators. A double-blind, randomized, placebo-controlled multicenter clinical trial to evaluate the effects of the angiotensin II receptor blocker candesartan cilexetil on intimal hyperplasia after coronary stent implantation. Am Heart J 2006;152:e1-6.
- Rouleau JL, Warnica WJ, Baillot R, et al, for the IMAGINE (Ischemia Management With Accupril Post-Bypass Graft via Inhibition of the Converting Enzyme) Investigators. Effects of angiotensin-converting enzyme inhibition in low-risk patients early after coronary artery bypass surgery. Circulation 2008;117:24-31.
- Coleman CI, Baker WL, Kluger J, et al. Comparative Effectiveness of Angiotensin-Converting Enzyme Inhibitors or Angiotensin II-Receptor Blockers Added to Standard Medical Therapy for Treating Stable Ischemic Heart Disease. Comparative Effectiveness Review No. 18. (Prepared by the University of Connecticut/Hartford Hospital Evidence-based Practice Center under Contract No. 290-2007-10067-I.) Rockville, MD: Agency for Healthcare Research and Quality; October 2009.
Your slide tray is being processed.