NEW YORK (Reuters Health) – Percutaneous coronary intervention with bare metal stents followed by a course of oral prednisone at immunosuppressive strength produces results comparable to that obtained with drug-eluting stents, an Italian team has shown.

The findings are reported in the May issue of the American Journal of Medicine by Dr. Flavio Ribichini, at the University of Verona, and colleagues. After previous success with prednisone treatment after PCI in patients with high C-reactive protein levels, the team studied the strategy in 375 PCI patients regardless of CRP levels.

They randomly allocated the participants to one of three groups: a control group given bare metal stents; a prednisone group receiving bare metal stents followed immediately by a 40-day course of oral prednisone; and a drug-eluting stent group.

All patients received dual antiplatelet therapy. The prednisone dosing schedule was: 1 mg/kg for the first 15 days; 0.5 mg/kg from days 16 to 30; and 0.25 mg/kg from days 31 to 40, according to the report. The prednisone group also received gastroprotective medication and treatment to reduce fluid retention.

The primary endpoint was 1-year survival free of cardiovascular death, MI or repeated target vessel revascularization. “Patients receiving bare metal stents alone compared to those treated with bare metal stents and prednisone or drug-eluting stents had a lower event-free survival at 1 year,” the investigators found.

Specifically, on an intention-to-treat basis, the endpoint rate was 80.8% in the bare metal stent group, 88.0% in the bare metal stent and prednisone group (hazard ratio = 0.505; p=0.04), and 88.8% in the drug-eluting stent group (HR = 0.388; p=0.006).

The differences were largely attributable to the rates of target vessel revascularization: 17.6% in the bare metal stent group, versus 12.0% in the prednisone group and 11.2% in the drug-eluting stent arm.

Summing up, Dr. Ribichini and colleagues write: “In this randomized controlled trial, the use of paclitaxel- or sirolimus-eluting stents and the short-course oral treatment with prednisone on top of optimal medical treatment was associated with a 40% reduction of major adverse cardiac events compared to the use of bare metal stents and optimal medical treatment.”

Reference:
Immunosuppressive Therapy with Oral Prednisone to Prevent Restenosis after PCI. A Multicenter Randomized Trial
Am J Med 2011;124:434-443.