Differences in the inflammatory response between patients with and those without diabetes mellitus after coronary stenting.
BACKGROUND
Patients with diabetes mellitus who undergo coronary stenting are at increased risk of restenosis. It is known that inflammation plays a crucial role in restenosis.


OBJECTIVE
We assessed the inflammatory response to elective coronary stent implantation (CSI) in stable diabetic and nondiabetic patients.


METHODS
C-reactive protein (CRP), soluble (s) P-selectin, and soluble intercellular adhesion molecule (sICAM)-1 plasma levels were determined in diabetic (n = 51) and nondiabetic (n = 56) patients before and 48 hours and 4 weeks after bare metal stenting (BMS).


RESULTS
Diabetic patients presented significantly higher inflammatory marker levels before and after CSI. Nonetheless, diabetic and nondiabetic patients had postintervention peak of markers attained within 48 hours. At baseline, diabetic and nondiabetic patients presented CRP levels of 5.0 +/- 20.1 (P < or = 0.04) and 3.8 +/- 9.4 microg/ml and, at 48 hours postintervention, 22.0 +/- 20.2 (P = 0.001; P = 0.002) and 12.6 +/- 11.3 (P < or = 0.0001) microg/ml. Regarding sP-selectin, diabetic and nondiabetic patients obtained levels of, at baseline, 182 +/- 118 (P < or = 0.04) and 105 +/- 48 ng/ml and, at 48 hours, 455 +/- 290 (P = 0.001; P < or = 0.01) and 215 +/- 120 (P < or = 0.04) ng/ml. For diabetic and nondiabetic patients, sICAM-1 levels were, at baseline, 248 +/- 98 (P < or = 0.04) and 199 +/- 94 ng/ml and, at 48 hours, 601 +/- 201 (P = 0.001; P < or = 0.01) and 283 +/- 220 (P = 0.001) ng/ml. At 4 weeks, for all patients, markers returned to preprocedural levels: versus before PCI: *P = 0.001, (section sign)P < or = 0.0001; versus nondiabetic patients: (#)P < or = 0.04, (paragraph sign)P = 0.002, (Upsilon)P < or = 0.01.


CONCLUSIONS
Diabetic and nondiabetic patients exhibited a temporal inflammatory response after an elective BMS. However, diabetic patients present higher preprocedural levels of CRP, sP-selectin, and sICAM-1 and reveal a further exacerbated inflammatory response after intervention. The differences in inflammatory response may have implications in restenosis within these two sets of patients.
Paiva
Maria Sanali M O
MS
Heart Institute (InCor), Medical School, University of São Paulo, São Paulo, SP, Brazil.
Serrano
Carlos V
CV
Nicolau
José Carlos
JC
Jalbut
Bruna O
BO
Fernandes
Juliano L
JL
De Lemos
James A
JA
Blotta
Maria Heloísa S L
MH
De Oliveira
Rômulo T D
RT
De Oliveira
Itamar R
IR
De Oliveira
Ludmilla Da A R R
Lda A
Ramires
José Antônio F
JA
D000368:Aged; D000787:Angina Pectoris / Q000628:therapy; D002097:C-Reactive Protein / Q000032:analysis*; D003251:Constriction, Pathologic; D003920:Diabetes Mellitus / Q000097:blood*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007249:Inflammation / Q000097:blood* / Q000209:etiology; D018799:Intercellular Adhesion Molecule-1 / Q000097:blood*; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D019007:P-Selectin / Q000097:blood*; D015607:Stents / Q000009:adverse effects*; D016896:Treatment Outcome
D019007:P-Selectin; D018799:Intercellular Adhesion Molecule-1; D002097:C-Reactive Protein