title: [Clinical value of inflammatory biomarkers after stent implantation].
abstract: The introduction of coronary stents into clinical practice has revolutionized the treatment of coronary artery disease. However, in-stent restenosis (ISR) and stent thrombosis represent the main adverse reactions following stent implantation. Along with procedural and technical factors, individual susceptibility, in particular the inflammatory response, play an important role in the development of these complications. C-reactive protein, one of the most extensively studied inflammatory biomarkers, was found to predict the risk of ISR but not of stent thrombosis in bare-metal stent (BMS)-treated patients. On the contrary, C-reactive protein failed to predict the occurrence of ISR in drug-eluting stent (DES)-treated patients, but it appeared to predict the risk of stent thrombosis. Important differences in the pathophysiological mechanisms of adverse reactions to BMS and DES account for the differences in the prognostic value of inflammatory biomarkers. Moreover, DES polymers are responsible for late hypersensitivity allergic reactions that may lead to late ISR and stent thrombosis. Notably, a correct employment of inflammatory biomarkers may become a useful tool for identification and management of high-risk patients. In this review, the evolving role of inflammatory biomarkers in predicting adverse reactions after stent implantation is discussed, underlying therapeutic and clinical consequences for the management of patients receiving a BMS or a DES.
authors.affiliation: Istituto di Cardiologia, Universita cattolica del Sacro Cuore, Largo, Roma, Italy. gniccoli73@hotmail.it
authors.forename: Giampaolo
authors.initials: G
authors.lastname: Niccoli
authors.forename: Rocco A
authors.initials: RA
authors.lastname: Montone
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Ferrante
authors.forename: Silvia
authors.initials: S
authors.lastname: Minelli
authors.forename: Filippo
authors.initials: F
authors.lastname: Crea
mesh_terms: D015906:Angioplasty, Balloon, Coronary / Q000379:methods; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism*; D003324:Coronary Artery Disease / Q000628:therapy; D023903:Coronary Restenosis / Q000097:blood* / Q000209:etiology / Q000517:prevention & control*; D004359:Drug Therapy, Combination; D054855:Drug-Eluting Stents / Q000009:adverse effects; D019317:Evidence-Based Medicine; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D007249:Inflammation / Q000097:blood / Q000517:prevention & control; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011237:Predictive Value of Tests; D011379:Prognosis; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D015607:Stents / Q000009:adverse effects*; D013927:Thrombosis / Q000097:blood / Q000517:prevention & control; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D005938:Glucocorticoids; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D010975:Platelet Aggregation Inhibitors; D002097:C-Reactive Protein