Enhanced inflammatory response following coronary stent implantation in stable angina patients.
BACKGROUND
Percutaneous coronary intervention (PCI) is associated with an increase in inflammatory activity. However, little is known about the association between the inflammatory response post-PCI and plaque morphology. The objective of this study was to characterize the inflammatory response following coronary stent implantation (CSI) of stable atherosclerotic plaques, according to plaque morphology.


METHODS
The study population consisted of 62 patients with stable angina that had an elective indication of CSI. Immediately before CSI, the patients underwent intravascular ultrasound (IVUS) for determination of the predominant plaque morphology of the target lesion: calcified (C, n=15), fibrocalcified (FC, n=16), fibrolipidic (FL, n=16), or lipidic (L, n=15). Angiographic lesion types were also determined. Coronary sinus samples were collected at baseline (BL) and 15 min after CSI for measuring inflammatory mediators (IM): interleukin-6 (IL-6, in pg/ml), tumoral necrosis factor-alpha (TNF, in pg/ml), interferon-gamma (IFN, in IU/ml), and neopterin (N, in ng/ml).


RESULTS
BL IL-6, TNF, IFN, and N were, respectively, for C plaques (mean+/-S.D.): 1.3+/-3.0, 8.0+/-3.5, 0.1+/-0.2, and 3.2+/-0.8; for FC plaques: 6.7+/-3.3, 1.9+/-2.0, 0.1+/-0.1, and 3.8+/-2.0; for FL plaques: 0.7+/-0.9, 8.7+/-4.3, 0.1+/-0.2, and 4.0+/-2.4; and, for L plaques: 1.9+/-2.8, 0.9+/-1.4, 0.0+/-0.1, and 5.2+/-3.3. After 15 min of CSI, percentual changes of IL-6, TNF, IFN, and N, respectively, were for C plaques: 43.8+/-19.6%, 7.7+/-5.5%, -7.5+/-5.3%, and -20.0+/-11.2%; for FC plaques: 7.7+/-5.5%, 168.4+/-56.9%, 311.1+/-159.9%, and 0%; for FL plaques: 147.5+/-16.1%*, 714.3+/-34.4%*, 116.1+/-9.9%*, and 3000.0+/-230.0%*; and, for L plaques: 147.7+/-14.4%*, 140.3+/-15.0%*, 131.6+/-11.9%*, and 2300.0+/-25.9%*. Moreover, B1 (n=28) and B2 (n=32) predominated and resulted in significant changes only for IL-6 and IFN, respectively. *P<0.05: 15 min vs BL.


CONCLUSIONS
These data suggest that stable angina patients with predominant lipidic (L and FL) plaques present a greater inflammatory response after CSI in than those with predominant calcified (C and FC) plaques.
Serrano
Carlos V
CV
Heart Institute (InCor), University of São Paulo, Medical School, Brazil. carlos.serrano@incor.usp.br
Santos
Elise S
ES
Mangione
José A
JA
Scheinberg
Morton
M
Souza
Juliana S
JS
Martinez
Eulogio E
EE
Ramires
José A
JA
Nicolau
José C
JC
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D000787:Angina Pectoris / Q000097:blood* / Q000145:classification* / Q000628:therapy*; D017023:Coronary Angiography; D005260:Female; D006801:Humans; D018836:Inflammation Mediators / Q000097:blood*; D007371:Interferon-gamma / Q000097:blood; D015850:Interleukin-6 / Q000097:blood; D008297:Male; D008875:Middle Aged; D019798:Neopterin / Q000097:blood; D015607:Stents; D014409:Tumor Necrosis Factor-alpha / Q000097:blood; D018084:Ultrasonography, Interventional
D018836:Inflammation Mediators; D015850:Interleukin-6; D014409:Tumor Necrosis Factor-alpha; D019798:Neopterin; D007371:Interferon-gamma