This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Serruys, P. W. Articles by Simon, R. Search for Related Content PubMed PubMed Citation Articles by Serruys, P. W. Articles by Simon, R. Pubmed/NCBI databases Compound via MeSH Substance via MeSH Medline Plus Health Information Angioplasty Antioxidants Hazardous Substances DB CARVEDILOL Related Collections Restenosis Catheter-based coronary interventions: stents

(Circulation. 2000;101:1512.)
© 2000 American Heart Association, Inc.

Clinical Investigation and Reports

Carvedilol for Prevention of Restenosis After Directional Coronary Atherectomy

Final Results of the European Carvedilol Atherectomy Restenosis (EUROCARE) Trial

Patrick W. Serruys, MD, PhD, FESC; David P. Foley, MB, PhD, MRCPI, FESC; Berthold Höfling, MD, PhD, FESC; Jacques Puel, MD, FESC; Helmut D. Glogar, MD; Ricardo Seabra-Gomes, MD, FESC; Javier Goicolea, MD; Pierre Coste, MD; Wolfgang Rutsch, MD, FESC; Hugo Katus, MD; Hans Bonnier, MD, FESC; William Wijns, MD, PhD, FESC; Amadeo Betriu, MD, FESC; Ulrike Hauf-Zachariou, MD, MSPM; Eline Montauban van Swijndregt, BSc; Rein Melkert, MD; Rudiger Simon, MD, FESC, on behalf of the EUROCARE study group

From Rotterdam, The Netherlands (P.W.S., D.P.F.); Münich, Germany (B.H.); Toulouse, France (J.P.); Vienna, Austria (H.D.G.); Kiel, Germany (R.S.); Linda-a-Velha, Portugal (R.S.-G.); Madrid, Spain (J.G.); Bordeaux, France (P.C.); Berlin, Germany (W.R.); Heidelberg, Germany (H.K.); Eindhoven, The Netherlands (H.B.); Aalst, Belgium (W.W.); Barcelona, Spain (A.B.); Boehringher Mannheim, Germany (U.H.-Z.); Cardialysis, Rotterdam, The Netherlands (E.M.v.S., R.M.).

Correspondence to Prof P.W. Serruys, MD, PhD, Thoraxcenter Bd418, Academic Hospital Rotterdam, Dr Molewaterplein 40, 3015 GD Rotterdam, The Netherlands. E-mail serruys{at}card.azr.nl

Background—In addition to its known properties as a competitive, nonselective ß and -1 receptor blocker, carvedilol directly inhibits vascular myocyte migration and proliferation and exerts antioxidant effects that are considerably greater than those of vitamin E or probucol. This provides the basis for an evaluation of carvedilol for the prevention of coronary restenosis.

Methods and Results—In a prospective, double-blind, randomized, placebo-controlled trial, 25 mg of carvedilol was given twice daily, starting 24 hours before scheduled directional coronary atherectomy and continuing for 5 months after a successful procedure. The primary end point was the minimal luminal diameter as determined during follow-up angiography 26±2 weeks after the procedure. Of 406 randomized patients, 377 underwent attempted atherectomy, and in 324 (88.9%), a 50% diameter stenosis was achieved without the use of a stent. Evaluable follow-up angiography was available in 292 eligible patients (90%). No differences in minimal luminal diameter (1.99±0.73 mm versus 2.00±0.74 mm), angiographic restenosis rate (23.4% versus 23.9%), target lesion revascularization (16.2 versus 14.5), or event-free survival (79.2% versus 79.7%) between the placebo and carvedilol groups were observed at 7 months.

Conclusions—The maximum recommended daily dose of the antioxidant and ß-blocker carvedilol failed to reduce restenosis after successful atherectomy. These findings are in contrast to those of the Multivitamins and Probucol Trial, which raises doubts regarding the validity of the interpretation that restenosis reduction by probucol was via antioxidant effects. The relationship between antioxidant agents and restenosis remains to be elucidated.

Key Words: restenosis • prevention • atherectomy • carvedilol • angiography • ß-blocker • antioxidants

This article has been cited by other articles:

				J.-W. Chen, F.-Y. Lin, Y.-H. Chen, T.-C. Wu, Y.-L. Chen, and S.-J. Lin Carvedilol Inhibits Tumor Necrosis Factor-{alpha}-Induced Endothelial Transcription Factor Activation, Adhesion Molecule Expression, and Adhesiveness to Human Mononuclear Cells Arterioscler Thromb Vasc Biol, November 1, 2004; 24(11): 2075 - 2081. [Abstract] [Full Text] [PDF]

				S.-P. Yang, L.-J. Ho, Y.-L. Lin, S.-M. Cheng, T.-P. Tsao, D.-M. Chang, Y.-L. Hsu, C.-Y. Shih, T.-Y. Juan, and J.-H. Lai Carvedilol, a new antioxidative {beta}-blocker, blocks in vitro human peripheral blood T cell activation by downregulating NF-{kappa}B activity Cardiovasc Res, September 1, 2003; 59(3): 776 - 787. [Abstract] [Full Text] [PDF]

				S Miketic, J Carlsson, and U Tebbe Clinical and angiographic outcome after conventional angioplasty with optional stent implantation compared with direct stenting without predilatation Heart, December 1, 2002; 88(6): 622 - 626. [Abstract] [Full Text] [PDF]

				A. Farb, M. John, E. Acampado, F. D. Kolodgie, M. F. Prescott, and R. Virmani Oral Everolimus Inhibits In-Stent Neointimal Growth Circulation, October 29, 2002; 106(18): 2379 - 2384. [Abstract] [Full Text] [PDF]

				J. G F Cleland, J. John, J. Dhawan, and A. Clark What is the optimal medical management of ischaemic heart failure? Br. Med. Bull., October 1, 2001; 59(1): 135 - 158. [Abstract] [Full Text] [PDF]

				J.-C. Tardif, J. Gregoire, P. W. Serruys, D. P. Foley, B. Hofling, J. Puel, H. D. Glogar, R. Seabra-Gomes, J. Goicolea, P. Coste, et al. Antioxidants and Prevention of Restenosis After Directional Coronary Atherectomy Response Circulation, February 27, 2001; 103 (8): e51 - e52. [Full Text] [PDF]