Effect of perindopril on coronary remodelling: Insights from a multicentre, randomized study

Aims: This study sought to evaluate the effect of perindopril in coronary remodelling. Methods and results: In this sub-study of a double-blind, multicentre trial, patients without clinical evidence of heart failure were randomized to perindopril 8 mg/day or placebo for at least 3 years and IVUS investigation was performed at both time-points. Positive and negative remodelling were defined as a relative increase (positive remodelling) or decrease (negative remodelling) of the mean vessel cross-sectional area (CSA) > 2 SD of the mean intra-observer difference. A total of 118 matched evaluable IVUS (711 matched 5 mm segments) were available at follow-up. After a median follow-up of 3.0 (inter-quartile range 1.9, 4.1) years, there was no significant difference in the change of plaque CSA between perindopril (360 segments) and placebo (351 segments) groups, P = 0.27. Conversely, the change in vessel CSA was significantly different between groups (perindopril -0.18 ± 2.4 mm2vs. placebo 0.19 ± 2.4, P = 0.04). Negative remodelling occurred more frequently in the perindopril than in the placebo group (34 vs. 25%, P = 0.01). In addition, the placebo group showed a larger, although not significant, mean remodelling index (RI) than the perindopril group (1.03 ± 0.2 vs. 1.00 ± 0.2, P = 0.06). The temporal change in vessel dimensions assessed by the RI was significantly correlated with the change in plaque dimensions (r = 0.48, P < 0.0001). Conclusion: In this sub-analysis of a multicentre, controlled study, long-term administration of perindopril was associated with a constrictive remodelling pattern without affecting the lumen.

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