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(Circulation. 1998;97:429-436.)
© 1998 American Heart Association, Inc.

Clinical Investigation and Reports

Prevention of Restenosis After Angioplasty in Small Coronary Arteries With Probucol

Josep Rodés, MD; Gilles Côté, MD; Jacques Lespérance, MD; Martial G. Bourassa, MD; Serge Doucet, MD; Luc Bilodeau, MD; Olivier F. Bertrand, MD; François Harel, MSc; Richard Gallo, MD; ; Jean-Claude Tardif, MD

From the Interventional Cardiology Laboratories and Department of Medicine, Montreal Heart Institute, Québec, Canada.

Correspondence to Jean-Claude Tardif, MD, Montreal Heart Institute, Research Center, 5000 Belanger St, Montreal, Quebec, Canada, H1T 1C8.

Background—Restenosis remains the major limitation of coronary angioplasty. Coronary stents have reduced the incidence of restenosis in selected patients with relatively large vessels. No strategies to date have demonstrated a beneficial effect in vessels < 3.0 mm in diameter. We have shown in the MultiVitamins and Probucol (MVP) Trial that probucol, a potent antioxidant, reduces restenosis after balloon angioplasty. The purpose of this study was to determine whether the benefit of probucol therapy is maintained in the subgroup of patients with smaller coronary vessels.

Methods and Results—We studied a subgroup of 189 patients included in the MVP trial who underwent successful balloon angioplasty of at least one coronary segment with a reference diameter < 3.0 mm. One month before angioplasty, patients were randomly assigned to one of four treatments: placebo, probucol (500 mg), multivitamins (beta-carotene 30 000 IU, vitamin C 500 mg, and vitamin E 700 IU), or probucol plus multivitamins twice daily. The treatment was maintained until follow-up angiography was performed at 6 months. The mean reference diameter of this study population was 2.49±0.34 mm. Lumen loss was 0.12±0.34 mm for probucol, 0.25±0.43 mm for the combined treatment, 0.35±0.56 mm for vitamins, and 0.38±0.51 mm for placebo (P=.005 for probucol). Restenosis rates per segment were 20.0% for probucol, 28.6% for the combined treatment, 45.1% for vitamins, and 37.3% for placebo (P=.006 for probucol).

Conclusions—Probucol reduces lumen loss and restenosis rate after balloon angioplasty in small coronary arteries.

Key Words: angioplasty • antioxidants • restenosis

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