title: Steroid-eluting stents in patients with acute coronary syndrome: the dexamethasone eluting stent Italian registry.
abstract: 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.
authors.affiliation: The Università del Piemonte Orientale, Ospedale Maggiore della Carità, Novara, Italy. flavio.ribichini@med.unipmn.it
authors.forename: Flavio
authors.initials: F
authors.lastname: Ribichini
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Tomai
authors.forename: Leonardo
authors.initials: L
authors.lastname: Paloscia
authors.forename: Germano
authors.initials: G
authors.lastname: Di Sciascio
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Carosio
authors.forename: Michele
authors.initials: M
authors.lastname: Romano
authors.forename: Edoardo
authors.initials: E
authors.lastname: Verna
authors.forename: Mario
authors.initials: M
authors.lastname: Galli
authors.forename: Corrado
authors.initials: C
authors.lastname: Tamburino
authors.forename: Nicoletta
authors.initials: N
authors.lastname: De Cesare
authors.forename: Raimondo
authors.initials: R
authors.lastname: Pirisi
authors.forename: Federico
authors.initials: F
authors.lastname: Piscione
authors.forename: Giorgio
authors.initials: G
authors.lastname: Lanteri
authors.forename: Valeria
authors.initials: V
authors.lastname: Ferrero
authors.forename: Corrado
authors.initials: C
authors.lastname: Vassanelli
mesh_terms: 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
chemical_list: D000893:Anti-Inflammatory Agents; D004343:Drug Implants; D003907:Dexamethasone