Steroid-eluting stents in patients with acute coronary syndrome: the dexamethasone eluting stent Italian registry.
OBJECTIVE
To assess immediate and mid-term clinical and angiographic outcomes of the dexamethasone drug-eluting stent (D-DES) in patients with acute coronary syndrome (ACS).


METHODS
A prospective, nationwide, controlled, registry. Inflammation plays a key role in ACS, and the anti-inflammatory effects of local elution of dexamethasone in unstable plaques may represent a valid therapeutic approach. All patients had ACS on admission (n = 332). 81.5% of the patients had unstable angina and 18.5% had non-ST elevation myocardial infarction (MI). 47% had ST-T segment changes, 59% had troponin elevation, 77% had elevated C-reactive protein levels and 48% had intermediate-high Thrombolysis in Myocardial Infarction risk score. Patients were treated according to an early invasive approach with 420 D-DES in 387 coronary lesions. Primary end point was the cumulative incidence of death, MI and ischaemia-driven target vessel revascularisation (TVR) at 6 months.


RESULTS
At 30 days, 2 (0.6%) patients died, and sub-acute stent thrombosis occurred in 2 patients. At 6 months, 328 (98.8%) patients were controlled, 3 (0.9%) patients had died, 7 (2.1%) had MI and 28 (8.5%) underwent ischaemia-driven TVR. Therefore, the primary end point occurred in 11.5% of patients. At multivariate analysis, multi-vessel coronary artery disease (odds ratio (OR) = 2.16, 95% CI = 1.47 to 3.17, p = 0.0001) and vessel diameter < or =2.75 mm (OR = 1.64, 95% CI = 1.08 to 2.49, p = 0.02) were independent predictors of 6-month clinical events. Global angiographic restenosis rate was 33.3%.


CONCLUSIONS
This is the first large, multicentre analysis of the clinical and angiographic outcomes obtained with D-DES implanted in ACS. D-DES offers a low rate of clinical events at 6 months, but has no anti-restenosis effect.
Ribichini
Flavio
F
The Università del Piemonte Orientale, Ospedale Maggiore della Carità, Novara, Italy. flavio.ribichini@med.unipmn.it
Tomai
Fabrizio
F
Paloscia
Leonardo
L
Di Sciascio
Germano
G
Carosio
Giuseppe
G
Romano
Michele
M
Verna
Edoardo
E
Galli
Mario
M
Tamburino
Corrado
C
De Cesare
Nicoletta
N
Pirisi
Raimondo
R
Piscione
Federico
F
Lanteri
Giorgio
G
Ferrero
Valeria
V
Vassanelli
Corrado
C
D000328:Adult; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D003327:Coronary Disease / Q000188:drug therapy*; D023903:Coronary Restenosis / Q000517:prevention & control; D016757:Death, Sudden, Cardiac / Q000209:etiology; D003907:Dexamethasone / Q000008:administration & dosage*; D004343:Drug Implants; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000379:methods; D012042:Registries; D015607:Stents; D016896:Treatment Outcome
D000893:Anti-Inflammatory Agents; D004343:Drug Implants; D003907:Dexamethasone