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Circulating intermediate monocytes CD14++CD16+ are increased after elective percutaneous coronary intervention
Ioannis Merinopoulos1,2, U Bhalraam1,2, Terri Holmes2
1Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, United Kingdom.
Insights
Intermediate monocytes increase two months after percutaneous coronary intervention (PCI), particularly with drug-eluting stents (DES). This suggests PCI strategy influences the inflammatory response post-procedure.
Area of Science:
- Cardiovascular Medicine
- Immunology
- Interventional Cardiology
Background:
- Inflammation is key in atherosclerosis and post-percutaneous coronary intervention (PCI) complications.
- Intermediate monocytes (CD14++CD16+) are linked to adverse cardiovascular events.
- Monocyte subset changes after elective PCI are not well-documented.
Purpose of the Study:
- To investigate monocyte subset and humoral responses following elective PCI.
- To compare responses between drug-coated balloon (DCB) and drug-eluting stent (DES) groups.
Main Methods:
- Prospective study of 30 patients undergoing elective PCI.
- Blood samples analyzed at baseline, 4 hours, 2 weeks, and 2 months post-PCI.
- Monocyte subsets, gene expression (CD14+ leucocytes), and humoral biomarkers were assessed.
Main Results:
- Intermediate monocytes decreased at 4 hours, recovered at 2 weeks, and increased at 2 months post-PCI.
- Elevated intermediate monocytes persisted at 2 months in the DES group, but not the DCB group.
- Biomarkers IL6 and TNFα remained elevated until 2 months post-PCI.
Conclusions:
- Elective PCI leads to a significant increase in intermediate monocytes at 2 months.
- The PCI strategy (DES vs. DCB) may modulate the post-PCI inflammatory response.
- Intermediate monocyte elevation post-PCI, especially with DES, warrants further investigation.
Aim:
Inflammation plays a central role in the pathogenesis of atherosclerosis and in the sequelae of percutaneous coronary intervention (PCI). Previous work demonstrated that intermediate monocytes (CD14++CD16+) are associated with adverse cardiovascular events, yet monocyte subset response following elective PCI has not been described. This article explores the changes in monocyte subset and humoral response after elective PCI.
Methods:
This prospective study included 30 patients without inflammatory diseases being referred for elective PCI. We included patients treated with drug coated balloons or 2nd generation drug eluting stents. Patients underwent blood tests at baseline (prior to PCI), four hours, two weeks and two months later. Analyses were performed in terms of monocyte subsets (classical CD14++CD16-, intermediate CD14++CD16+ and non-classical CD14+CD16++), gene expression of CD14+ leucocytes and humoral biomarkers.
Results:
Intermediate monocytes decreased significantly four hours after PCI, were recovered at two weeks, and increased significantly at two months post elective, uncomplicated PCI. They remain significantly elevated in the DES group but not in the DCB group. Gene expression analysis of CD14+ leucocytes showed IL18 had decreased expression at two weeks, CXCR4 and IL1β decreased at two months, while pentraxin 3 increased at two weeks and two months. In terms of humoral biomarkers, hsTnI remains elevated up to two weeks post PCI while IL6 and TNFα remain elevated till two months post PCI.
Conclusion:
Intermediate monocytes increase significantly two months following elective, uncomplicated PCI. They remain significantly elevated in the DES group but not in the DCB group suggesting that the PCI strategy could be one of the ways to modulate the inflammatory response post PCI.
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