Prediction of cardiovascular events by inflammatory markers in patients undergoing carotid stenting.
OBJECTIVE
To assess whether inflammatory markers predict atherosclerotic disease activity after carotid treatment in patients with severe carotid stenosis and nonsignificant coronary artery disease undergoing carotid stenting.


METHODS
From March 1, 2004, to September 30, 2005, a total of 55 consecutive patients (mean ± SD age, 69±8.3 years; 26 men) with severe carotid stenosis and nonsignificant coronary artery disease were treated with carotid stent implantation. Patients were followed up for a period of 5 years for the occurrence of cardiovascular events.


RESULTS
A significant correlation between quantitative analysis of debris entrapped in the filters and inflammatory markers was found. Moreover, the number of particles per filter, the total particles area, and the mean particle axis per filter were significantly higher in patients with clinical events at the follow-up compared with patients without events (87 vs 32, P=.006; 50,118.7 vs 17,782, P=.002; 33.9 vs 30.2, P=.03). At 5-year follow-up we recorded cardiovascular or neurologic events in 11 of the 55 patients (20%). Higher preprocedural levels of high-sensitivity C-reactive protein, interleukin 6 soluble receptor, and interleukin 6 were significantly associated with clinical events at follow-up (P<.001, P=.05, and P=.02, respectively). In particular high-sensitivity C-reactive protein measured at 24 and 48 hours after carotid stenting showed a significant correlation with clinical events (P=.001). Also preprocedural intracellular adhesion molecule 1 and circulating vascular cell adhesion molecule 1 blood concentrations were significantly correlated with a worse prognosis at follow-up (P=.04 and P=.03, respectively).


CONCLUSIONS
In patients with severe carotid stenosis and nonsignificant coronary artery disease, inflammation is associated with atherosclerotic disease activity and a worse prognosis. Interleukin 6, interleukin 6 soluble receptor, intracellular adhesion molecule 1, vascular cell adhesion molecule 1, and high-sensitivity C-reactive protein levels at baseline and 24 and 48 hours after carotid stenting are predictive of neurologic and cardiovascular events at follow-up.
Dipartimento di Cardiologia Ospedale Civile di Mirano, Università Tor Vergata, Rome, Italy. francescoversaci@yahoo.it
Francesco
F
Versaci
Bernhard
B
Reimers
Francesco
F
Prati
Achille
A
Gaspardone
Costantino
C
Del Giudice
Andrea
A
Pacchioni
Alessandro
A
Mauriello
Claudio
C
Cortese
Paolo
P
Nardi
Anna
A
De Fazio
Giovanni Alfonso
GA
Chiariello
Igino
I
Proietti
Luigi
L
Chiariello
D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000627:therapeutic use; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis; D002318:Cardiovascular Diseases / Q000097:blood / Q000209:etiology; D016893:Carotid Stenosis / Q000097:blood* / Q000150:complications / Q000628:therapy; D003324:Coronary Artery Disease / Q000097:blood*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007249:Inflammation / Q000097:blood* / Q000175:diagnosis / Q000503:physiopathology; D015850:Interleukin-6 / Q000097:blood; D008297:Male; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use; D011237:Predictive Value of Tests; D011379:Prognosis; D015607:Stents; D016896:Treatment Outcome
D000894:Anti-Inflammatory Agents, Non-Steroidal; D015415:Biomarkers; D015850:Interleukin-6; D010975:Platelet Aggregation Inhibitors; D002097:C-Reactive Protein