effect of fimasartan for modification of atheroma vulnerability in deferred coronary disease (fima-defer)

Conditions: Coronary Artery Disease

Summary: * fimasartan will be more beneficial in stabilizing the plaque vulnerability compared to control group in deferred coronary lesions. * fimasartan will be more beneficial in reducing total plaque volume compared to control group in deferred coronary lesions. * fimasartan will be more beneficial in reducing functional impairment of stenotic lesions (assessed by ffr:fractional flow reserve) in deferred coronary lesions.

prospective, double-blind, randomized clinical study with enrollment of patients over at least 18 years of age who require coronary angiography for a clinical indication with hypertension defined as systolic blood pressure \>140mmhg or diastolic blood pressure \>90mmhg. inclusion requires at least one deferred coronary lesion with 1) visually-estimated angiographic %diameter stenosis 20-50% or 2) %diameter stenosis \>50% without any evidence of inducible ischemia. the target vessel for ivus interrogation must not have undergone angioplasty (deferred lesion) nor have more than 50% luminal narrowing throughout a target segment. patients meeting inclusion criteria without any exclusion criteria will be randomized 1:1 (fimasartan 60-120 mg vs placebo). all subjects will be followed up at 1 year for serial vh-ivus and conventional ivus evaluation. also, oct sub-study will be performed in selected patients with lesions at least 20 mm distally located from coronary ostium. all patients will be blindly assigned to control and fimasartan once daily as 1:1 ratio and are prescribed for 1year.

Eligibility criteria:
inclusion criteria: 1. hypertensive patients (systolic blood pressure \>140mmhg or diastolic blood pressure \>90mmhg) or medically treated hypertension with normal blood pressure who undergo coronary angiography with clinical indications 2. 18 \< age \< 85 3. patient who has received informed consent 4. at least one deferred coronary lesion with 1) visually-estimated angiographic %diameter stenosis 20-50% or 2) %diameter stenosis \>50% without any evidence of inducible ischemia (ffr ≥ 0.8 or negative perfusion defect on thallium scan or negative treadmill test) exclusion criteria: 1. planned cardiac surgery (e.g., cabg, valve repair or replacement, or aneurysmectomy) or planned major non-cardiac surgery within the study period 2. planned performance of pci or cabg in the target vessel or its branches containing the index 3. evidence of congestive heart failure, or left ventricular ejection fraction \< 40% 4. stroke or resuscitated sudden death in the past 6 months 5. chronic disease requiring treatment with oral, intravenous, or intra-articular corticosteroids (use of topical, inhaled, or nasal corticosteroids is permissible) 6. a diagnosis of cancer (other than superficial squamous or basal cell skin cancer) in the past 3 years or current treatment for the active cancer 7. any clinically significant abnormality identified at the screening visit, physical examination, laboratory tests, or electrocardiogram which, in the judgment of the investigator, would preclude safe completion of the study 8. significant renal disease manifested by serum creatinine \> 1.5 mg/dl 9. hepatic disease or biliary tract obstruction, or significant hepatic enzyme elevation (alt or ast \> 3 times upper limit of normal) 10. active hepatitis b or c or carrier 11. hypotension (systolic blood pressure \<90 mmhg) 12. patients already taking ace inhibitors or arbs 13. patients with stemi requiring primary pci 14. patients pregnant or breast-feeding or child-bearing potential 15. patients who are lack of intention for effective contraception 16. patients with history of previous enrollment into a clinical trials within 3 months 17. allergic or contraindicated to angiotensin ii antagonists 18. history of any arterial bypass or angioplastic intervention involving the target vessel 19. luminal narrowing in the left main \> 50% by visual inspection of angiogram 20. visually-estimated angiographic reference segment diameter of \ 4.0 mm 21. presence of thrombus or complex plaque morphology in the target vessel that suggests a high likelihood of distal embolism 22. severe tortuosity of the target vessel or any other anatomical reasons that the investigator deems 23. inappropriate for ivus procedures. vessel with thrombus (on gs-ivus), moderate or severe calcification, angulation 24. culprit vessel in ami 25. rwma (regional wall motion abnormality) or scar tissue in the territory subtended by the studied lesion