title: Impact of direct sirolimus-eluting stent implantation on the early systemic inflammatory response compared with complementary stent implantation.
abstract: BACKGROUND
  Systemic inflammation after percutaneous coronary intervention (PCI) identifies patients at increased risk of subsequent major adverse cardiac event. During PCI, the technique of stent implantation including direct stenting (DS) and complementary stenting (CS) is guided using both clinical and angiographic features. DS was practiced with increased frequency during PCI in an attempt to reduce both restenosis and major adverse cardiac event in the drug-eluting stent (DES) era. Impact of DS on the early inflammatory response has, however, not been investigated. We hypothesized that a direct DES implantation may attenuate the early inflammatory response compared with CS.
  
  
  OBJECTIVE
  In this study, therefore, we prospectively select the sirolimus-eluting stent (SES) as a model of DESs, and sought to determine the early systemic inflammatory response in patients with single-vessel disease after PCI using either DS or CS techniques.
  
  
  METHODS
  Thirty-nine patients who had single-vessel disease implanted with SES were randomly enrolled into the two groups: DS group (n=20) or CS group (n=19). The blood samples were taken before PCI, 24 and 72 h after stenting. The plasma concentrations of C-reactive protein and interleukin-6 (IL-6) were determined by enzyme-linked immunosorbent assay.
  
  
  RESULTS
  No significant difference in baseline clinical, angiographic, and inflammatory parameters between the two groups is observed. The plasma IL-6 levels at 24 h after stent implantation were significantly higher than that at baseline in both groups (P<0.05, respectively). Plasma IL-6 level was, however, higher in CS group than in DS group (P<0.01) and was returned to baseline levels in both groups at 72 h after stenting. Meanwhile, the plasma levels of C-reactive protein were also significant higher in CS group compared with DS group at both 24 and 72 h after stenting (P<0.05, respectively).
  
  
  CONCLUSIONS
  Taken together, our findings demonstrated that a direct SES implantation significantly attenuated the early systemic inflammatory response in patients with single-vessel disease compared with CS technique.
authors.affiliation: Department of Cardiology, Fu Wai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China. lijnjn@yahoo.com.cn
authors.forename: Jian-Jun
authors.initials: JJ
authors.lastname: Li
authors.forename: Yu-Ping
authors.initials: YP
authors.lastname: Zhang
authors.forename: Chun
authors.initials: C
authors.lastname: Wang
authors.forename: Li-Jian
authors.initials: LJ
authors.lastname: Gao
authors.forename: Xue-Wen
authors.initials: XW
authors.lastname: Qin
authors.forename: Bo
authors.initials: B
authors.lastname: Xu
authors.forename: Ji-Lin
authors.initials: JL
authors.lastname: Chen
authors.forename: Yue-Jin
authors.initials: YJ
authors.lastname: Yang
authors.forename: Run-Lin
authors.initials: RL
authors.lastname: Gao
mesh_terms: D000328:Adult; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation*; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism; D002317:Cardiovascular Agents / Q000008:administration & dosage*; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000276:immunology / Q000628:therapy*; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D018836:Inflammation Mediators / Q000097:blood; D015850:Interleukin-6 / Q000097:blood; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011474:Prosthesis Design; D020123:Sirolimus / Q000008:administration & dosage*; D018746:Systemic Inflammatory Response Syndrome / Q000209:etiology / Q000276:immunology / Q000517:prevention & control*; D013997:Time Factors; D016896:Treatment Outcome; D019210:Troponin I / Q000097:blood; D015854:Up-Regulation
chemical_list: D015415:Biomarkers; D002317:Cardiovascular Agents; C508600:IL6 protein, human; D018836:Inflammation Mediators; D015850:Interleukin-6; D019210:Troponin I; D002097:C-Reactive Protein; D020123:Sirolimus