Aims This study sought to evaluate the effect of perindopril in coronary remodelling.\ud Methods and results In this sub-study of a double-blind, multicentre trial, patients without clinical evidence\ud of heart failure were randomized to perindopril 8 mg/day or placebo for at least 3 years and IVUS\ud investigation was performed at both time-points. Positive and negative remodelling were defined as a\ud relative increase (positive remodelling) or decrease (negative remodelling) of the mean vessel crosssectional\ud area (CSA) .2 SD of the mean intra-observer difference. A total of 118 matched evaluable\ud IVUS (711 matched 5 mm segments) were available at follow-up. After a median follow-up of 3.0\ud (inter-quartile range 1.9, 4.1) years, there was no significant difference in the change of plaque CSA\ud between perindopril (360 segments) and placebo (351 segments) groups, P ¼ 0.27. Conversely, the\ud change in vessel CSA was significantly different between groups (perindopril 20.18+2.4 mm2 vs.\ud placebo 0.19+2.4, P ¼ 0.04). Negative remodelling occurred more frequently in the perindopril than\ud in the placebo group (34 vs. 25%, P ¼ 0.01). In addition, the placebo group showed a larger, although\ud not significant, mean remodelling index (RI) than the perindopril group (1.03+0.2 vs. 1.00+0.2,\ud P ¼ 0.06). The temporal change in vessel dimensions assessed by the RI was significantly correlated\ud with the change in plaque dimensions (r ¼ 0.48, P , 0.0001).\ud Conclusion In this sub-analysis of a multicentre, controlled study, long-term administration of perindopril\ud was associated with a constrictive remodelling pattern without affecting the lumen
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