Impact Of Probucol On Restenosis And Major Adverse Cardiovascular Events After PCI:a Meta-Analysis Of Random Control Trials

Background Even though stent implantation has significantly reduced the risk of restenosis after percutaneous coronary intervention (PCI) comparing with balloon angioplasty, the occurrences of restenosis and adverse cardiac events remain harmful. Probucol, a typical antioxidant drug, may have the potential of further reducing restenosis and cardiac events after PCI. We systematically reviewed randomized clinical trials (RCTs) and did a meta-analysis to evaluate its effect on restenosis and major adverse cardiac events (MACEs) after PCI.Methods We searched RCTs in PubMed and Cochrane library (August2011). Quantitative meta-analyses were performed to assess differences between probucol groups and controls with respect to post-PCI risk of MACEs, angiographic restenosis and late loss in luminal diameter.Results10RCTs were identified, involving1038patients receiving PCI for coronary artery diseases. Pooled analysis showed that probucol significantly reduced angiographic restenosis (RR0.57,95%CI0.44to0.74; P<0.0001), late loss in luminal diameter (Std Mean Difference (SMD)-0.41,95%CI-0.60to-0.23; P<0.00001) and MACEs (RR0.57,95%CI0.42to0.78;P=0.0005) in patients with balloon angioplasty; with no benefit of preventing MACEs (RR0.98,95%CI0.57to1.67; P=0.93) and restenosis (RR0.71,95%CI0.50to1.01; P=0.05) in patients with stent implantation, although with significant reductions in late loss (SMD-0.31,95%CI-0.50to-0.11; P<0.002). Conclusion Probucol might be an effective strategy for preventing restenosis and MACEs after balloon angioplasty, but failed to show benefit after stent implantation. More experimental studies and large scale RCTs are still needed to clarify its innate mechanism and possible clinical value. Background Even though stent implantation has significantly reduced the risk of restenosis after percutaneous coronary intervention (PCI) comparing with balloon angioplasty, the occurrences of restenosis and adverse cardiac events remain harmful. Probucol, a typical antioxidant drug, may have the potential of further reducing restenosis and cardiac events after PCI. We systematically reviewed randomized clinical trials (RCTs) and did a meta-analysis to evaluate its effect on restenosis and major adverse cardiac events (MACEs) after PCI.Methods We searched RCTs in PubMed and Cochrane library (August2011). Quantitative meta-analyses were performed to assess differences between probucol groups and controls with respect to post-PCI risk of MACEs, angiographic restenosis and late loss in luminal diameter.Results10RCTs were identified, involving1038patients receiving PCI for coronary artery diseases. Pooled analysis showed that probucol significantly reduced angiographic restenosis (RR0.57,95%CI0.44to0.74; P<0.0001), late loss in luminal diameter (Std Mean Difference (SMD)-0.41,95%CI-0.60to-0.23; P<0.00001) and MACEs (RR0.57,95%CI0.42to0.78; P=0.0005) in patients with balloon angioplasty; with no benefit of preventing MACEs (RR0.98,95%CI0.57to1.67; P=0.93) and restenosis (RR0.71,95%CI0.50to1.01; P=0.05) in patients with stent implantation, although with significant reductions in late loss (SMD-0.31,95%CI-0.50to-0.11; P<0.002).Conclusion Probucol might be an effective strategy for preventing restenosis and MACEs after balloon angioplasty, but failed to show benefit after stent implantation. More experimental studies and large scale RCTs are still needed to clarify its innate mechanism and possible clinical value.