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Published on: January 21, 2020
Comparison of changes in early inflammatory markers between sirolimus- and paclitaxel-eluting stent implantation
Jian-Jun Li1, Hong-Bing Yan, Xiao-Ping Xiang
1Department of Cardiology, Fu Wai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, People's Republic of China. lijnjn@yahoo.com.cn
Insights
Sirolimus-eluting stents (SES) show a lower inflammatory response compared to paclitaxel-eluting stents (PES) after coronary intervention. This reduced inflammation with SES may be linked to better long-term outcomes, reducing restenosis.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Biomarkers of Inflammation
Background:
- Systemic inflammation post-coronary intervention is a risk factor for cardiac events.
- Sirolimus-eluting stents (SES) are associated with fewer cardiac events, particularly in-stent restenosis, than paclitaxel-eluting stents (PES).
- The mechanisms behind this disparity, specifically the inflammatory response, require further investigation.
Purpose of the Study:
- To compare the early systemic inflammatory response between SES and PES implantation in patients with single-vessel disease.
- To assess the relationship between the inflammatory response and late clinical outcomes following stent implantation.
- To conduct a randomized comparison of inflammatory markers and clinical outcomes.
Main Methods:
- A randomized trial involving 32 patients with stable angina, assigned to either SES or PES groups (n=16 each).
- Peripheral blood samples were collected pre-procedure, and at 24 and 72 hours post-stenting.
- Plasma levels of C-reactive protein (CRP) and interleukin-6 (IL-6) were measured using ELISA, with clinical and angiographic follow-up at 8 months.
Main Results:
- Both SES and PES implantation increased CRP and IL-6 levels post-procedure compared to baseline.
- The paclitaxel-eluting stent (PES) group exhibited significantly higher plasma IL-6 at 24 hours and CRP at 72 hours compared to the sirolimus-eluting stent (SES) group.
- While major adverse cardiac events and restenosis rates were similar at 8 months, late lumen loss was significantly greater in the PES group than the SES group.
Conclusions:
- Drug-eluting stent implantation can induce a systemic inflammatory response.
- Sirolimus-eluting stent (SES) implantation is associated with a lower inflammatory response compared to paclitaxel-eluting stent (PES) implantation.
- The reduced inflammatory response with SES may contribute to less late lumen loss observed at 8-month follow-up.
Background:
Systemic inflammation after coronary intervention identifies patients at increased risk of subsequent cardiac events. Cardiac events, especially in-stent restenosis, are less frequent after use of sirolimus-eluting stent (SES) compared with paclitaxel-eluting stent (PES). However, the underlying mechanism for this disparity is not well investigated. We hypothesize that an attenuated inflammatory response after SES implantation may be a contributor.
Purpose:
In the present study, we sought to determine the early inflammatory response after SES implantation in patients with single-vessel disease compared with PES implantation, and evaluate the relationship between inflammatory response and late clinical outcomes in a randomized design.
Methods:
Thirty-two patients with stable angina were randomly enrolled into the two groups, SES or PSE group (n = 16 respectively). Peripheral blood samples were taken before PCI, 24 and 72 h after stenting. The plasma concentrations of C-reactive protein (CRP) and interleukin-6 (IL-6) were determined by enzyme-linked immunosorbent assay (ELISA). The clinical and angiographic follow-up was performed at 8 months after stenting.
Results:
The data showed that there was no significant difference in clinical and angiographic baseline characteristics between the two groups. The plasma CRP and IL-6 levels at 24 h after stenting were significant higher in both groups compared with baseline (p < 0.01 respectively). Likewise, the CRP levels at 72 h after stenting were also significant higher compared with baseline in both groups (p < 0.01 respectively). However, the plasma levels of IL-6 at 24 h and CRP at 72 h after stenting were higher in PES group compared with SES group (p < 0.05). At 8 months follow-up, the rates of major adverse cardiac events, target lesion revascularization, in-stent and in-segment restenosis were similar in both groups. However, the late loss in both in-stent and in-segment was significantly higher in the PES group than in SES group (p < 0.001 respectively).
Conclusions:
Our findings suggest that a drug-eluting stent implantation could trigger a systemic inflammatory response as previously demonstrated. However, SES implantation results in a lower inflammatory response compared with PES implantation, which seems to be associated with greater late of in-stent and in-segment loss at 8-month follow-up with PES.
