The IMPRESS-2 trial represents a consecutive series of patients with diffuse and multi-vessel coronary artery disease treated with multiple bare metal stents. Eighty-three patients with CRP greater than 0.5 mg/dl 72 hours post PCI with single stent received a 1 mg/kg oral dose of prednisone for the first 10 days, 0.5 mg/kg from day 11 to 30, and 0.25 mg/kg from day 21 to 45, with clinical follow-up at 1, 6 and 12 months. The aim of the study was to assess the safety and applicability of high-dose oral prednisone. Inclusion criteria included patients with angina pectoris and documented ischemia, multi-vessel disease treated successfully with PCI or POBA or rotational angioplasty, for any lesion type and any stent length or diameter. Additional inclusion criteria included any CRP value before starting or CRP under 3 mg/dl 48 hours after the PCTA. Exclusion criteria were Q-wave MI in the previous 3 weeks, an active peptic ulcer or gastritis, uncontrolled severe hypertension, and diabetes.

Presenting the 6 month results, Dr Flavio Ribichini, Novara, Italy, reported restenosis rates in the prednisone group of 7% compared to 33% for the control group (p=0.001). Late loss was 0.39 mm ± 0.6mm in the same group compared to 0.85 mm for controls. TVR was 7% and 33% respectively, and event-free survival at 93% vs. 86%, thus demonstrating the efficacy of oral immunosuppressant therapy in lowering restenosis rates.

While drug-eluting stents have dramatically reduced stenosis, Dr Ribichini commented that they have not completely eliminated the problem. He also suggested that the use of DES is strictly limited by the combination of the cost of DES and the lack absence of long-term safety data.