Immunosuppressive Therapy for the Prevention of Restenosis after Coronary Artery Stent Implantation (IMPRESS Study).
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.
Versaci
Francesco
F
Cattedra di Cardiochirurgia, Divisione di Cardiochirurgia, Università Tor Vergata, European Hospital, Rome, Italy. francescoversaci@yahoo.it
Gaspardone
Achille
A
Tomai
Fabrizio
F
Ribichini
Flavio
F
Russo
Paolo
P
Proietti
Igino
I
Ghini
Anna Silvia
AS
Ferrero
Valeria
V
Chiariello
Luigi
L
Gioffrè
Pier Agostino
PA
Romeo
Francesco
F
Crea
Filippo
F
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
D007166:Immunosuppressive Agents; D002097:C-Reactive Protein; D011241:Prednisone