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Steroid-eluting stents in patients with acute coronary syndrome: the Dexamethasone Eluting Stent Italian REgistry
  1. Flavio Ribichini1,
  2. Fabrizio Tomai2,
  3. Leonardo Paloscia3,
  4. Germano Di Sciascio4,
  5. Giuseppe Carosio5,
  6. Michele Romano6,
  7. Edoardo Verna7,
  8. Mario Galli8,
  9. Corrado Tamburino9,
  10. Nicoletta De Cesare10,
  11. Raimondo Pirisi11,
  12. Federico Piscione12,
  13. Giorgio Lanteri13,
  14. Valeria Ferrero1,
  15. Corrado Vassanelli1,
  16. on behalf of the DESIRE investigators
  1. 1The Università del Piemonte Orientale, Ospedale Maggiore della Carità, Novara, Italy
  2. 2European Hospital, Rome, Italy
  3. 3Ospedale S Spirito, Pescara, Italy
  4. 4Campus Biomedico, Rome, Italy
  5. 5Ospedale S Antonio e Biagio e C Arrigo, Alessandria, Italy
  6. 6Ospedale Carlo Poma, Mantova, Italy
  7. 7Ospedale di Circolo, Varese, Italy
  8. 8Ospedale S Anna, Como, Italy
  9. 9Università di Catania, Ospedale Ferrarotto, Catania, Italy
  10. 10Policlinico S Marco, Zingonia, Italy
  11. 11Ospedale S Giovanni di Dio, Cagliari, Italy
  12. 12Università di Napoli, Policlinico Federico II, Naples, Italy
  13. 13Cardioricerche, Milan, Italy
  1. Correspondence to:
    Professor F Ribichini
    Catheterisation Laboratory, Università del Piemonte Orientale, Ospedale Maggiore della Carità, Corso Mazzini 18, 28100 Novara, Italy; flavio.ribichini{at}med.unipmn.it

Abstract

Objective: To assess immediate and mid-term clinical and angiographic outcomes of the dexamethasone drug-eluting stent (D-DES) in patients with acute coronary syndrome (ACS).

Patients and methods: A prospective, nationwide, controlled, registry. Inflammation plays a key role in ACS, and the anti-inflammatory effects of local elution of dexamethasone in unstable plaques may represent a valid therapeutic approach. All patients had ACS on admission (n = 332). 81.5% of the patients had unstable angina and 18.5% had non-ST elevation myocardial infarction (MI). 47% had ST-T segment changes, 59% had troponin elevation, 77% had elevated C-reactive protein levels and 48% had intermediate–high Thrombolysis in Myocardial Infarction risk score. Patients were treated according to an early invasive approach with 420 D-DES in 387 coronary lesions. Primary end point was the cumulative incidence of death, MI and ischaemia-driven target vessel revascularisation (TVR) at 6 months.

Results: At 30 days, 2 (0.6%) patients died, and sub-acute stent thrombosis occurred in 2 patients. At 6 months, 328 (98.8%) patients were controlled, 3 (0.9%) patients had died, 7 (2.1%) had MI and 28 (8.5%) underwent ischaemia-driven TVR. Therefore, the primary end point occurred in 11.5% of patients. At multivariate analysis, multi-vessel coronary artery disease (odds ratio (OR) = 2.16, 95% CI = 1.47 to 3.17, p = 0.0001) and vessel diameter ⩽2.75 mm (OR = 1.64, 95% CI = 1.08 to 2.49, p = 0.02) were independent predictors of 6-month clinical events. Global angiographic restenosis rate was 33.3%.

Conclusion: This is the first large, multicentre analysis of the clinical and angiographic outcomes obtained with D-DES implanted in ACS. D-DES offers a low rate of clinical events at 6 months, but has no anti-restenosis effect.

  • ACS, acute coronary syndrome
  • BMS, bare metal stents
  • DES, drug-eluting stent
  • D-DES, dexamethasone DES
  • DESIRE, Dexamethasone Eluting Stent Italian REgistry
  • MACE, major adverse cardiac events
  • MI, myocardial infarction
  • NSTE, non-ST-segment elevation
  • PCI, percutaneous coronary intervention
  • TVR, target vessel revascularisation

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Footnotes

  • Published Online First 27 September 2006

  • Funding: The study was partially supported by Abbott Vascular Devices (Redwood City, California, USA) and Endotech (Como, Italy). The study sponsors had no role in the data analysis, statistical analysis, data interpretation, writing of the report or in the decision to submit the article for publication. FR received a research grant from the study sponsors and was reimbursed of travel expenses for presentation of the results of the study at scientific meetings.

  • Competing interests: None.

  • The Dexamethasone Eluting Stent Italian REgistry (DESIRE) investigators are listed in the appendix.

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