Dexamethasone-eluting stents and plasma concentrations of adhesion molecules in patients with unstable coronary syndromes: results of the historically controlled SESAME study.
BACKGROUND
Plasma concentrations of intercellular adhesion molecule-1 [ICAM-1], vascular cell adhesion molecule-1 [VCAM-1], and E-selectin may increase after percutaneous coronary intervention (PCI).


OBJECTIVE
The aim of this study was to assess whether anti-inflammatory treatment with steroid-eluting stents influenced concentrations of adhesion molecules after PCI in patients with unstable coronary syndromes.


METHODS
Consecutive patients with unstable coronary syndromes who were prospectively assigned to undergo implantation of a dexamethasone-eluting stent were compared with a control group of consecutive historical patients who received a similar non-drugeluting stent in the period immediately preceding availability of the steroid-eluting stents. Circulating concentrations of adhesion molecules were measured before the procedure and at 6 and 24 hours after implantation.


RESULTS
The study included 50 patients who received the dexamethasone-eluting stent (41 men, 9 women; mean [SD] age, 60 [9] years) and 50 historical controls who received the non-drug-eluting stent (40 men, 10 women; mean age, 63 [11] years). Baseline values for the adhesion molecules were similar in the 2 groups: in patients who received the dexamethasone-eluting stent, mean (SD) values were 210 (41) ng/mL for ICAM-1, 637 (119) ng/mL for VCAM-1, and 46 (9) ng/mL for E-selectin; in the control group, the corresponding values were 218 (42), 618 (140), and 43 (10) ng/mL. Circulating concentrations at 24 hours were significantly lower in patients receiving the drug-eluting stent compared with controls for both ICAM-1 (279 [49] vs 338 [60] ng/mL, respectively; P = 0.001) and VCAM-1 (772 [163] vs 896 [207] ng/mL; P = 0.004). There was no significant between-group difference in E-selectin concentrations at 24 hours (60 [10] vs 56 [11] ng/mL).


CONCLUSIONS
In this study, dexamethasone-eluting stents reduced plasma concentrations of ICAM-1 and VCAM-1 after PCI in patients with unstable coronary syndromes compared with historical controls.
Patti
Giuseppe
G
Department of Cardiovascular Sciences, Campus Bio-Medico University, Rome, Italy.
Chello
Massimo
M
Pasceri
Vincenzo
V
Colonna
Diego
D
Carminati
Patrizia
P
Covino
Elvio
E
Di          Germano
Sciascio
S
D000704:Analysis of Variance; D000789:Angina, Unstable / Q000097:blood / Q000628:therapy; D015906:Angioplasty, Balloon, Coronary; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D015815:Cell Adhesion Molecules / Q000097:blood*; D003324:Coronary Artery Disease / Q000097:blood / Q000188:drug therapy*; D003327:Coronary Disease / Q000097:blood / Q000188:drug therapy* / Q000628:therapy; D003907:Dexamethasone / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D018799:Intercellular Adhesion Molecule-1 / Q000097:blood; D008297:Male; D009203:Myocardial Infarction / Q000097:blood / Q000628:therapy; D015607:Stents; D013577:Syndrome; D013997:Time Factors; D019010:Vascular Cell Adhesion Molecule-1 / Q000097:blood; D044465:White People
D000893:Anti-Inflammatory Agents; D015815:Cell Adhesion Molecules; D019010:Vascular Cell Adhesion Molecule-1; D018799:Intercellular Adhesion Molecule-1; D003907:Dexamethasone