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Published on: January 28, 2020
Prediction of cardiovascular events by inflammatory markers in patients undergoing carotid stenting
Francesco Versaci1, Bernhard Reimers, Francesco Prati
1Dipartimento di Cardiologia Ospedale Civile di Mirano, Università Tor Vergata, Rome, Italy. francescoversaci@yahoo.it
Insights
Inflammatory markers like high-sensitivity C-reactive protein predict atherosclerotic disease activity and cardiovascular events after carotid stenting. Elevated levels indicate a worse prognosis in patients with severe carotid stenosis.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Biomarkers and Inflammation
Background:
- Severe carotid stenosis poses a significant risk for cardiovascular events.
- Carotid stenting is a common treatment, but predicting post-procedural outcomes remains crucial.
- The role of inflammatory markers in assessing atherosclerotic disease activity post-treatment requires further investigation.
Purpose of the Study:
- To determine if inflammatory markers can predict atherosclerotic disease activity following carotid stenting.
- To evaluate the prognostic value of specific inflammatory markers in patients with severe carotid stenosis and non-significant coronary artery disease.
Main Methods:
- A cohort of 55 patients with severe carotid stenosis underwent carotid stenting between March 2004 and September 2005.
- Patients were monitored for 5 years to record cardiovascular or neurological events.
- Preprocedural and post-procedural (24 and 48 hours) levels of inflammatory markers (hs-CRP, IL-6, sIL-6R, ICAM-1, VCAM-1) were measured.
Main Results:
- A significant correlation was observed between quantitative analysis of filter debris and inflammatory markers.
- Higher levels of hs-CRP, IL-6, sIL-6R, ICAM-1, and VCAM-1 were significantly associated with increased risk of clinical events at 5-year follow-up.
- hs-CRP levels measured 24 and 48 hours post-stenting strongly correlated with clinical events.
Conclusions:
- Inflammation is closely linked to atherosclerotic disease activity and poorer prognosis in patients undergoing carotid stenting.
- Baseline and early post-procedural levels of hs-CRP, IL-6, sIL-6R, ICAM-1, and VCAM-1 are predictive of future neurological and cardiovascular events.
Objective:
To assess whether inflammatory markers predict atherosclerotic disease activity after carotid treatment in patients with severe carotid stenosis and nonsignificant coronary artery disease undergoing carotid stenting.
Patients And Methods:
From March 1, 2004, to September 30, 2005, a total of 55 consecutive patients (mean ± SD age, 69±8.3 years; 26 men) with severe carotid stenosis and nonsignificant coronary artery disease were treated with carotid stent implantation. Patients were followed up for a period of 5 years for the occurrence of cardiovascular events.
Results:
A significant correlation between quantitative analysis of debris entrapped in the filters and inflammatory markers was found. Moreover, the number of particles per filter, the total particles area, and the mean particle axis per filter were significantly higher in patients with clinical events at the follow-up compared with patients without events (87 vs 32, P=.006; 50,118.7 vs 17,782, P=.002; 33.9 vs 30.2, P=.03). At 5-year follow-up we recorded cardiovascular or neurologic events in 11 of the 55 patients (20%). Higher preprocedural levels of high-sensitivity C-reactive protein, interleukin 6 soluble receptor, and interleukin 6 were significantly associated with clinical events at follow-up (P<.001, P=.05, and P=.02, respectively). In particular high-sensitivity C-reactive protein measured at 24 and 48 hours after carotid stenting showed a significant correlation with clinical events (P=.001). Also preprocedural intracellular adhesion molecule 1 and circulating vascular cell adhesion molecule 1 blood concentrations were significantly correlated with a worse prognosis at follow-up (P=.04 and P=.03, respectively).
Conclusion:
In patients with severe carotid stenosis and nonsignificant coronary artery disease, inflammation is associated with atherosclerotic disease activity and a worse prognosis. Interleukin 6, interleukin 6 soluble receptor, intracellular adhesion molecule 1, vascular cell adhesion molecule 1, and high-sensitivity C-reactive protein levels at baseline and 24 and 48 hours after carotid stenting are predictive of neurologic and cardiovascular events at follow-up.
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