title: Differences in the inflammatory response between patients with and those without diabetes mellitus after coronary stenting.
abstract: 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.
authors.affiliation: Heart Institute (InCor), Medical School, University of São Paulo, São Paulo, SP, Brazil.
authors.forename: Maria Sanali M O
authors.initials: MS
authors.lastname: Paiva
authors.forename: Carlos V
authors.initials: CV
authors.lastname: Serrano
authors.forename: José Carlos
authors.initials: JC
authors.lastname: Nicolau
authors.forename: Bruna O
authors.initials: BO
authors.lastname: Jalbut
authors.forename: Juliano L
authors.initials: JL
authors.lastname: Fernandes
authors.forename: James A
authors.initials: JA
authors.lastname: De Lemos
authors.forename: Maria Heloísa S L
authors.initials: MH
authors.lastname: Blotta
authors.forename: Rômulo T D
authors.initials: RT
authors.lastname: De Oliveira
authors.forename: Itamar R
authors.initials: IR
authors.lastname: De Oliveira
authors.forename: Ludmilla Da A R R
authors.initials: Lda A
authors.lastname: De Oliveira
authors.forename: José Antônio F
authors.initials: JA
authors.lastname: Ramires
mesh_terms: 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
chemical_list: D019007:P-Selectin; D018799:Intercellular Adhesion Molecule-1; D002097:C-Reactive Protein