Immunosuppressive oral prednisone after percutaneous interventions in patients with multi-vessel coronary artery disease. The IMPRESS-2/MVD study.

Abstract

To assess efficacy and safety of oral treatment with prednisone at immunosuppressive dose after percutaneous coronary interventions (PCI) in patients with multi-vessel coronary artery disease (CAD). Eighty-six consecutive patients with multi-vessel CAD were successfully treated with multiple PCI. Forty-three patients (115 coronary stenoses), with C-reactive protein >3mg/L 48 hours after PCI and in absence of contra-indications received 45-day high-dose oral prednisone treatment (study-group). Forty-three patients (106 coronary stenoses), did not receive prednisone (control-group). The primary clinical endpoint was 12-month event-free survival rate (defined as freedom from death, myocardial infarction, and the need for target vessel revascularisation). Angiographic restenosis at 8 months was assessed in the study group only. Event-free survival rates were 93 and 69.8% in the study and the control group, respectively (relative risk 0.34, 95%CI: 0.12 to 0.96, p=0.006). Target vessel revascularisation rate in the study group was 7% compared to 27.9% in the control group (p=0.01). Quantitative coronary angiography performed on 104 lesions of 39 prednisone-treated patients (91%) showed 4 restenotic lesions (3.8%). The mean late lumen loss was 0.61+/-0.35mm and loss index 31.3+/-21.6%. Oral immunosuppression with prednisone effectively reduces clinical restenosis in patients undergoing complex, multi-vessel PCI.