Oral prednisone for 45 days improved 12-month event-free survival compared to placebo in patients with high CRP after coronary stenting (93% vs 65%; RR 0.18, 95% CI 0.05-0.61, p=0.0063).
RCT (n=83)
Relative Risk: 0.18 (95% CI 0.05–0.61)
Absolute Event Rate: 93% vs 65%
p-value: p=0.0063
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.
“Since the IMPRESS I randomized trial was positive, the authors did not want to repeat a similar design but have rather attempted to verify the efficacy of short-term, high-dose, oral prednisone treatment in patients and lesions at much higher risk of restenosis.”
Versaci et al. (Sun,) conducted a rct in Coronary artery stent implantation with persistent inflammation (n=83). Oral prednisone vs. Placebo was evaluated on 12-month event-free survival rate (freedom from death, myocardial infarction, and recurrence of symptoms requiring additional revascularization) (RR 0.18, 95% CI 0.05 to 0.61, p=0.0063). Oral prednisone for 45 days improved 12-month event-free survival compared to placebo in patients with high CRP after coronary stenting (93% vs 65%; RR 0.18, 95% CI 0.05-0.61, p=0.0063).