The effect of hydrocortisone on reducing rates of restenosis and target lesion revascularization after coronary stenting less than 3 mm in stent diameter.
OBJECTIVE
Stenting of small coronary arteries has always been limited by high rates of restenosis, and restenosis has mainly been attributed to inflammatory reactions resulting in cell proliferation and intimal hyperplasia. Based on our experience for several years, we retrospectively investigated the effect of hydrocortisone on reducing in-stent restenosis.


METHODS
Study population consisted of consecutive 166 patients, 221 lesions, who electively underwent stent implantations stent diameter less than 3 mm into coronary arteries between February 1999 and October 2002. We intravenously administered hydrocortisone before the procedure to 40 patients for preventing allergic reactions due to contrast material, and the effect of hydrocortisone on reducing restenosis was retrospectively compared with 126 patients who did not receive this treatment.


RESULTS
There was no significant difference in the prevalence of diabetes mellitus, hyperlipidemia, or hypertension between the two groups. There was no significant difference in the type of lesion, length of stent, balloon/artery ratio, or initial success rate between the two groups, but stent diameter was significantly smaller in the hydrocortisone group compared with the control group. On six-month angiographic follow-up, the restenosis rate was significantly lower in the hydrocortisone group compared with the control group (16.2% vs 34.0%, respectively), and the target lesion revascularization rate was also significantly lower in the hydrocortisone group compared with the control group (13.2% vs 27.5%, respectively).


CONCLUSIONS
These results suggest that intravenous administration of hydrocortisone reduces in-stent restenosis of small coronary arteries. Prospectively controlled trials will be necessary to confirm this preventive effect of hydrocortisone.
Kakio
Tadashi
T
Department of Cardiology, Hamamatsu Rosai Hospital, Hamamatsu, Japan.
Matsumori
Akira
A
Ohashi
Naohiro
N
Yamada
Takehiko
T
Nobuhara
Mamoru
M
Saito
Takeji
T
Kawamoto
Akira
A
Taguchi
Atsushi
A
Morita
Yasuhiro
Y
Takahashi
Masaaki
M
Sasayama
Shigetake
S
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000494:pharmacology*; D023903:Coronary Restenosis / Q000000981:diagnostic imaging / Q000188:drug therapy*; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000008:administration & dosage / Q000494:pharmacology*; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012044:Regression Analysis; D012189:Retrospective Studies; D015607:Stents
D000893:Anti-Inflammatory Agents; D006854:Hydrocortisone