CLINICAL STUDY
Immunosuppressive therapy for the prevention of restenosis after coronary artery stent implantation (IMPRESS study)
Francesco Versaci, MD, FACC*,*,
Achille Gaspardone, MPhil, MD, FACC*,
Fabrizio Tomai, MD, FACC*,
Flavio Ribichini, MD ,
Paolo Russo, MD ,
Igino Proietti, MD*,
Anna Silvia Ghini, MD*,
Valeria Ferrero, MD,
Luigi Chiariello, MD, FACC*,
Pier Agostino Gioffrè, MD¶,
Francesco Romeo, MD, FACC and
Filippo Crea, MD, FACC||
* Cattedra di Cardiochirurgia, Università Tor Vergata, Rome, Italy
Divisione di Cardiologia, Università del Piemonte Orientale, Novara, Italy
Divisione di Cardiologia, Ospedale S. Croce e Carle, Cuneo, Italy
Cattedra di Cardiologia, Università Tor Vergata, Rome, Italy/AFF
|| Istituto di Cardiologia, Università Cattolica del Sacro Cuore, Rome, Italy
¶ European Hospital, RomeItaly
* Reprint requests and correspondence: Dr. Francesco Versaci, Divisione di Cardiochirurgia, Università di Roma Tor Vergata, European Hospital, via Portuense 700, 00149 Rome, Italy.
francescoversaci{at}yahoo.it
OBJECTIVES: 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.
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Abbreviations and Acronyms
| | CCS | | Canadian Cardiovascular Society | | CK | | creatine kinase | | CRP | | C-reactive protein | | MI | | myocardial infarction | | MLD | | minimal lumen diameter | | PTCA | | percutaneous transluminal coronary angioplasty | | TIMI | | Thrombolysis In Myocardial Infarction | | WHO | | World Health Organization |
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