title: Immunosuppressive Therapy for the Prevention of Restenosis after Coronary Artery Stent Implantation (IMPRESS Study).
abstract: OBJECTIVE
  This study tested the effect of oral prednisone on clinical and angiographic restenosis rate after successful stent implantation in patients with persistent elevation of systemic markers of inflammation after the procedure.
  
  
  BACKGROUND
  Experimental studies have shown that corticosteroids have the potential to reduce the inflammatory response associated with stent implantation.
  
  
  METHODS
  Eighty-three patients undergoing successful stenting with C-reactive protein (CRP) levels >0.5 mg/dl 72 h after the procedure were randomized to receive oral prednisone or placebo for 45 days. The primary clinical end point was 12-month event-free survival rate (defined as freedom from death, from myocardial infarction, and from recurrence of symptoms requiring additional revascularization). The angiographic end points were restenosis rate and late loss at six months.
  
  
  RESULTS
  Twelve-month event-free survival rates were 93% and 65% in patients treated with prednisone and placebo, respectively (relative risk [RR] 0.18, 95% confidence intervals [CI], 0.05 to 0.61, p = 0.0063). Six-month restenosis rate and late loss were lower in prednisone-treated than in placebo-treated patients (7% vs. 33%, p = 0.001, and 0.39 +/- 0.6 mm vs. 0.85 +/- 0.6 mm, p = 0.001, respectively).
  
  
  CONCLUSIONS
  In patients with persistently high CRP levels after successful coronary artery stent implantation, oral immunosuppressive therapy with prednisone results in a striking reduction of clinical events and angiographic restenosis rate.
authors.affiliation: Cattedra di Cardiochirurgia, Divisione di Cardiochirurgia, Università Tor Vergata, European Hospital, Rome, Italy. francescoversaci@yahoo.it
authors.forename: Francesco
authors.initials: F
authors.lastname: Versaci
authors.forename: Achille
authors.initials: A
authors.lastname: Gaspardone
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Tomai
authors.forename: Flavio
authors.initials: F
authors.lastname: Ribichini
authors.forename: Paolo
authors.initials: P
authors.lastname: Russo
authors.forename: Igino
authors.initials: I
authors.lastname: Proietti
authors.forename: Anna Silvia
authors.initials: AS
authors.lastname: Ghini
authors.forename: Valeria
authors.initials: V
authors.lastname: Ferrero
authors.forename: Luigi
authors.initials: L
authors.lastname: Chiariello
authors.forename: Pier Agostino
authors.initials: PA
authors.lastname: Gioffrè
authors.forename: Francesco
authors.initials: F
authors.lastname: Romeo
authors.forename: Filippo
authors.initials: F
authors.lastname: Crea
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects; D002097:C-Reactive Protein / Q000187:drug effects / Q000378:metabolism; D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000097:blood / Q000000981:diagnostic imaging / Q000517:prevention & control*; D018572:Disease-Free Survival; D004311:Double-Blind Method; D023381:Endpoint Determination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017202:Myocardial Ischemia / Q000097:blood / Q000150:complications / Q000628:therapy; D011237:Predictive Value of Tests; D011241:Prednisone / Q000627:therapeutic use; D015607:Stents; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents; D002097:C-Reactive Protein; D011241:Prednisone