The use of angiotensin converting enzyme (ACE) inhibitors may prevent repeat revascularization in patients who underwent percutaneous transluminal angioplasty (PTA) for peripheral artery disease (PAD) compared with angiotensin receptor blockers (ARB), according to a presentation at APCH 2017.

Researchers evaluated 519 patients (77.8 percent male) with symptomatic PAD who have undergone PTA using standard techniques such as balloon angioplasty or stenting. More than half of the participants received either ACE inhibitors (n=61) or ARB (n=209), while the other 249 individuals neither had any of these two types of drugs. Clinical outcomes were evaluated at 1 year. [APCH 2017, abstract 5134]

At 1 year, there were no incidences of repeat revascularization of coronary artery disease (CAD) in those who had ACE inhibitors compared with those who had ARB (0 percent vs 4.5 percent; p=0.029). However, ACE inhibitor use was associated with higher total death (10.3 percent vs 2.5 percent; p=0.028) and noncardiac death rates (8.6 percent vs 2.0 percent; p=0.046) vs ARB use.

Adjusted multiple regression analysis showed that ACE inhibitors were an independent predictor for preventing repeat revascularization of CAD (hazard ratio, 0.345; p=0.009).

Compared with participants who received ARB, those who had ACE inhibitors had lower left ventricular ejection fraction (52 vs 56.9; p<0.001), higher incidence of significant CAD (73.7 percent vs 57.4 percent; p=0.001), and history of myocardial infarction (11.4 percent vs 7.6 percent; p=0.008), percutaneous coronary intervention (37.7 percent vs 30.1 percent; p=0.036), and coronary artery bypass graft (6.5 percent vs 1.9 percent; p=0.055) at baseline.

On the other hand, ARB use was associated with a higher prevalence of hypertension (81.3 percent vs 70.4 percent; p<0.001) and diabetes (81.3 percent vs 73.7 percent; p<0.001) compared with ACE inhibitor use at baseline.

There were no significant complications except for the incidence of minor haematoma, which was higher in the ACE inhibitor vs ARB group (13.1 percent vs 3.8 percent; p=0.031).

Despite the cardiovascular risks associated with ACE inhibitor use, the findings establish the potential of ACE inhibitors for secondary cardiac prevention in the treatment of PAD, [Lancet 1993;342:821-828] which has been associated with poor outcomes. [Eur J Vasc Endovasc Surg 2004;28:573-582] “[ACE inhibitors] may be useful to improve clinical outcomes in patients [with significant PAD] who underwent PTA,” said the researchers.