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A Murine Model of Stent Implantation in the Carotid Artery for the Study of Restenosis
Published on: May 14, 2013
Effects of drug-eluting stents on systemic inflammatory response in patients with unstable angina pectoris undergoing
Nihat Ozer1, Burak Tangurek, Fatih Firat
1Cardiology Department, Siyami Ersek Cardiovascular and Thoracic Surgery Center, Istanbul, Turkey. drnihatozer@yahoo.com
Insights
Drug-eluting stents significantly reduce the inflammatory marker high-sensitivity C-reactive protein (hsCRP) after percutaneous coronary intervention compared to bare metal stents. This suggests drug-eluting stents effectively mitigate the acute inflammatory response post-procedure.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Inflammation Research
Background:
- Elevated inflammatory markers are implicated in acute coronary syndromes and stent restenosis.
- Drug-eluting stents (DESs) are known to reduce restenosis rates.
- The impact of DESs on systemic inflammatory response post-percutaneous coronary intervention (PCI) requires further investigation.
Purpose of the Study:
- To evaluate the effect of DES implantation on systemic inflammatory markers in patients with unstable angina.
- To compare plasma levels of high-sensitivity C-reactive protein (hsCRP), tumor necrosis factor alpha (TNF-alpha), and interleukin-6 (IL-6) after DES versus bare metal stent (BMS) implantation.
Main Methods:
- A study involving 90 patients with acute coronary syndrome undergoing PCI with a single stent.
- Patients were randomized into three groups: BMS, dexamethasone-eluting stent (DEXES), and sirolimus-eluting stent (SES) (n=30 each).
- Plasma inflammatory markers (hsCRP, TNF-alpha, IL-6) were measured before PCI and at 24 hours, 48 hours, and 1 week post-PCI.
Main Results:
- Plasma hsCRP levels were significantly lower at 48 hours and 7 days post-PCI in the DES groups (DEXES and SES) compared to the BMS group.
- Plasma TNF-alpha levels were higher in the SES group compared to BMS and DEXES groups at all time points, though the time course was similar.
- IL-6 levels showed no significant difference at baseline or early post-PCI, but were slightly higher in the SES group at 7 days.
Conclusions:
- Drug-eluting stents demonstrate a significantly reduced systemic inflammatory response, as indicated by lower hsCRP levels, compared to bare metal stents after PCI.
- DESs appear to exert potent effects in mitigating acute inflammatory reactions associated with PCI.
- Further research may elucidate the differential inflammatory responses observed between DEXES and SES.
Abstract:
Inflammatory markers are elevated in acute coronary syndromes, and are also known to play a crucial role in the pathogenesis of neointimal proliferation and stent restenosis. Drug-eluting stents (DESs) have been shown to decrease stent restenosis in different studies. In this study, we aimed to investigate the effect of treatment with DESs on systemic inflammatory response in patients with unstable angina pectoris who underwent percutaneous coronary intervention (PCI). We compared plasma high-sensitivity C-reactive protein (hsCRP), human tumor necrosis factor alpha (Hu TNF-alpha), and interleukin 6 (IL-6) levels after DES (dexamethasone-eluting stent [DEXES], and sirolimuseluting stent [SES]) implantation with levels after bare metal stent (BMS) implantation. We performed PCI with a single stent in 90 patients (62 men; 59 +/- 9 years of age; n = 30 in the BMS group, n = 30 in the DEXES group, n = 30 in the SES group) who had acute coronary syndrome. Plasma hsCRP, Hu TNF-alpha, and IL-6 levels were determined before intervention and at 24 h, 48 h, and 1 week after PCI. The results were as follows. Plasma hsCRP levels at 48 h (11.19 +/- 4.54, 6.43 +/- 1.63 vs 6.23 +/- 2.69 mg/l, P = 0.001) after stent implantation were significantly higher in the BMS group than in the DES group; this effect persisted for 7 days (P = 0.001). Plasma Hu TNF-alpha levels at each time point were higher in the SES group than in the BMS and DEXES groups (P < 0.05). The time course of Hu TNF-alpha values was similar in all groups. Although IL-6 levels at baseline and at 24 and 48 h showed no statistically significant difference between the study groups, postprocedural values at 7 days were slightly statistically significant in the SES group (P = 0.045). Drug-eluting stents showed significantly lower plasma hsCRP levels after PCI compared with BMSs. This may reflect the potent effects of DESs on acute inflammatory reactions induced by PCI.
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