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Persistent Inflammatory Activity in Blood Cells and Artery Tissue from Patients with Previous Bare Metal Stent

Pedro Silvio Farsky1, Mario H Hirata2, Renato Tambellini Arnoni1

  • 1Instituto Dante Pazzanese de Cardiologia, São Paulo, SP - Brazil.

Arquivos Brasileiros De Cardiologia
|July 19, 2018
PubMed

Insights

Patients with coronary artery bypass grafting (CABG) and stents show higher systemic tumor necrosis factor (TNF) and local TNF-alpha and interleukin-6 production. This inflammation may explain worse clinical outcomes after CABG in stented patients.

Area of Science:

  • Cardiovascular Surgery
  • Immunology
  • Biomedical Engineering

Background:

  • Coronary artery bypass grafting (CABG) surgery is associated with higher mortality in patients with prior stent implantation.
  • Inflammatory responses are implicated in the adverse outcomes following CABG in stented patients.

Purpose of the Study:

  • To compare inflammatory markers in peripheral blood and coronary artery tissues between patients with and without stents undergoing CABG.
  • To investigate the role of specific inflammatory genes and proteins in stented arteries.

Main Methods:

  • A case series comparing two groups: patients with previous stent implantation (n=41) and controls (n=26).
  • Analysis of gene expression (LIGHT, IL-6, ICAM, VCAM, CD40, NFKB, TNF, IFNG) in peripheral blood cells.
  • Immunohistochemical evaluation of inflammatory proteins (interleukin-6, ICAM, VCAM, CD40, NFKB, TNF-alpha, IFN-gamma) in 176 coronary artery tissue samples.

Main Results:

  • Patients with stents exhibited higher TNF gene expression and lower CD40 gene expression in peripheral blood cells compared to controls.
  • Coronary artery samples from stented patients (group A1) showed significantly higher TNF-alpha protein staining in intima-media and adipose tissue.
  • Elevated interleukin-6 protein staining was observed in the adipose tissue of stented patients (group A1) compared to controls (group A3).

Conclusions:

  • A persistently elevated systemic TNF expression, along with exacerbated local TNF-alpha and interleukin-6 production, was observed in patients with stents.
  • These heightened inflammatory markers may contribute to the poorer clinical outcomes reported in stented patients undergoing CABG.
Abstract

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