Comparison of Efficacy and Safety of Lower-Dose to Higher-Dose Oral Prednisone After Percutaneou Coronary Interventions (the IMPRESS-LD Study) Valeria Ferrero, MD a , Flavio Ribichini, MD a, *, Andrea Rognoni, MD b , Paolo Marino, MD b , Sandra Brunelleschi, MD c , and Corrado Vassanelli, MD a This study assessed clinical and angiographic efficacies of oral treatment with predni at low-dose (LD) versus the previous high-dose (HD) immunosuppressive dosage used percutaneous coronary interventions (PCIs) with bare metal stents in patients with m tivessel coronary artery disease. Forty-three patients with multivessel disease successfully treated with multiple PCIs were matched to the previous HD IMPRESS-2/MVD study population. The 43 patients were treated for 103 coronary stenoses and received 30- prednisone treatment (LD group 1 mg/kg for 5 days, 0.5 mg/kg for 10 days, 0.25 mg/k 15 days) and were compared retrospectively with the 43 patients in the HD IMPRESS- MVD study with 116 treated coronary lesions (HD group 1 mg/kg for 10 days, 0.5 mg/ for 20 days, 0.25 mg/kg for 15 days). The primary clinical end point was12-month event-free survival rate (defined as freedom from death, myocardial infarction, and need for target vessel revascularization). The secondary end point was angiographic resten 8 months assessed by quantitative coronary angiography. Event-free survival rates were 74% and 93% in the LD and HD groups, respectively (relative risk 4.6, 95% confidence interval 1.18 to 17.8, p ⴝ 0.019). Restenosis was observed in 4 lesions (4%) in the HD and in 20 lesions (22%) in the LD group (p <0.001). Mean late lumen loss was 0.61 ⴞ 0 mm, and the loss index was 31.3 ⴞ 21.6% in the HD group compared with 0.87 ⴞ 0.61 and 52.03 ⴞ 25.1% in the LD group (p ⴝ 0.03 and 0.02, respectively). In conclusion, antirestenotic efficacy of oral treatment with prednisone after conventional PCI is dose sensitive. A 50% dose decrease in oral prednisone, as tested in this study, is less effective than the previously tested HD IMPRESS therapeutic scheme. © 2007 Elsevier Inc. All rights reserved. (Am J Cardiol 2007;99:1082–1086) High-dose (HD) prednisone given orally for a short period of 45 days after percutaneous coronary intervention (PCI) with implantation of bare metal stentssignificantly de- creases the incidence of major cardiac events at 1 year in patients with multivessel disease (MVD) compared with controls (relative risk 0.34, 95% confidence interval [CI] 0.12 to 0.96, p ⬍0.006). 1 Similartreatment effects were obtained in patients treated with single-vessel intervention and HD prednisone (relative risk 0.18, 95% CI 0.05 to 0.61, p ⫽ 0.0063). 2 This study assessed clinical and angiographic efficacies and incidence of drug-related side effects of oral prednisone in patients with multivessel coronary artery dis- ease treated with PCI followed by a low-dose (LD) pred- nisone protocol. The lowerdose used in thistudy has anti-inflammatory effects but cannotbe considered effec- tively immunosuppressive. 3 The population of this study was matched to and compared with patients included in the previous HD Immunosuppressive Therapy for the Preven- tion of RestenosisAfterCoronaryStentImplantation (IMPRESS-2)/MVD study. 1 Methods The IMPRESS-LD is a prospective, controlled registry of patients with multivessel coronary artery disease and c cal evidence of ischemia amenable to PCI and without contraindication to stent implantation and subsequent ste- roid treatment. Use of prednisone to prevent restenosi PCI was approved by the ethical committee of our hosp and allpatients who enrolled gave their informed conse according to ethical regulations. Between January 2004 March 2005, 43 patients were selected for inclusion in study. The IMPRRESS-LD is a matched 1:1 comparison of t efficacy of oral prednisone treatment given at a lower d with a similar population previously enrolled in the full- dose IMPRESS-2/MVD study. 1 Patients were matched on a case-control basis considering age, gender, coronary risk factors, and angiographic features, i.e.,number and length of coronary stenoses. All patients had multivessel coro artery disease and clinical evidence of myocardial isch and were treated with multiple PCIs. After PCI, all pati started a treatment with oral prednisone that was decr in dosage and length by nearly 50% compared with pre a Division of Cardiology, Università di Verona, and b Division of Car- diology and c Department of Medical Science, Università del Piemonte Orientale, Novara, Italy.Manuscript received August 16,2006;revised manuscript received and accepted November 27, 2006. *Corresponding author: Tel: 39-045-812-2039; fax: 39-045-914-727. E-mail address: flavio.ribichini@univr.it (F. Ribichini). 0002-9149/07/$ – see front matter © 2007 Elsevier Inc. All rights reserved. www.AJConline.org doi:10.1016/j.amjcard.2006.11.064