Impact of direct sirolimus-eluting stent implantation on the early systemic inflammatory response compared with complementary stent implantation.
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.
Li
Jian-Jun
JJ
Department of Cardiology, Fu Wai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China. lijnjn@yahoo.com.cn
Zhang
Yu-Ping
YP
Wang
Chun
C
Gao
Li-Jian
LJ
Qin
Xue-Wen
XW
Xu
Bo
B
Chen
Ji-Lin
JL
Yang
Yue-Jin
YJ
Gao
Run-Lin
RL
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
D015415:Biomarkers; D002317:Cardiovascular Agents; C508600:IL6 protein, human; D018836:Inflammation Mediators; D015850:Interleukin-6; D019210:Troponin I; D002097:C-Reactive Protein; D020123:Sirolimus