title: Integrity(®) bare-metal coronary stent-induced platelet and endothelial cell activation results in a higher risk of restenosis compared to Xience(®) everolimus-eluting stents in stable angina patients.
abstract: Drug-eluting stenting (DES) has become a reliable tool for coronary stenting; however, its direct effects on platelet and endothelium function differ from those of bare-metal stenting (BMS). This study involved a periprocedural analysis of various biomarkers of cellular activation after elective DES (Xience(®), Abbott Vascular, Santa Clara, CA, USA) or BMS (Integrity(®), Medtronic, Minneapolis, MI, USA). Forty-nine stable angina patients were recruited: 28 underwent BMS, and 21 received everolimus-eluting stents. Samples were collected (i) prior to stenting, (ii) at 24 hours after procedure, and (iii) after 1 month of dual antiplatelet therapy. Platelet activation was analyzed by surface P-selectin positivity in parallel with plasma levels of soluble P-selectin, CD40L and platelet-derived growth factor (PDGF). Endothelial cell (EC) activation was detected by measuring markers of early (von Willebrand factor) and delayed response (VCAM-1, ICAM-1, E-selectin). Patients were followed for 6 months for the occurrence of restenosis or stent thrombosis. Increased platelet activation was sustained regardless of stent type or antiplatelet medication. Concentrations of most EC markers were more elevated after BMS than after DES. No stent thrombosis was seen, but six BMS subjects displayed restenosis with significantly higher sCD40L (779 [397-899] vs. 381 [229-498] pg/mL; p = 0.032) and sICAM-1 (222 [181-272] vs. 162 [153-223] ng/mL; p = 0.046) levels than in those without complication, while DES patients exhibited significantly decreased PDGF (572 [428-626] vs. 244 [228-311] pg/mL; p = 0.004) after 1 month. Nonresponsiveness to antiplatelet drugs did not influence these changes. In conclusion, the degree of platelet and EC activation suggests that Xience(®) DES may be regarded a safer coronary intervention than Integrity(®) BMS, with a lower risk of in-stent restenosis.
authors.affiliation: a Institute of Cardiology.
authors.forename: Tibor
authors.initials: T
authors.lastname: Szük
authors.affiliation: b Department of Laboratory Medicine, Faculty of Medicine , University of Debrecen , Debrecen , Hungary.
authors.forename: Zsolt
authors.initials: Z
authors.lastname: Fejes
authors.affiliation: b Department of Laboratory Medicine, Faculty of Medicine , University of Debrecen , Debrecen , Hungary.
authors.forename: Ildikó Beke
authors.initials: IB
authors.lastname: Debreceni
authors.affiliation: b Department of Laboratory Medicine, Faculty of Medicine , University of Debrecen , Debrecen , Hungary.
authors.forename: Adrienne
authors.initials: A
authors.lastname: Kerényi
authors.affiliation: a Institute of Cardiology.
authors.forename: István
authors.initials: I
authors.lastname: Édes
authors.affiliation: b Department of Laboratory Medicine, Faculty of Medicine , University of Debrecen , Debrecen , Hungary.
authors.forename: János
authors.initials: J
authors.lastname: Kappelmayer
authors.affiliation: b Department of Laboratory Medicine, Faculty of Medicine , University of Debrecen , Debrecen , Hungary.
authors.forename: Béla
authors.initials: B
authors.lastname: Nagy
mesh_terms: D000368:Aged; D060050:Angina, Stable / Q000150:complications* / Q000628:therapy*; D015415:Biomarkers; D001792:Blood Platelets / Q000378:metabolism; D023201:CD40 Ligand / Q000097:blood; D015897:Comorbidity; D023903:Coronary Restenosis / Q000097:blood* / Q000175:diagnosis / Q000209:etiology*; D054855:Drug-Eluting Stents; D042783:Endothelial Cells / Q000378:metabolism*; D000068338:Everolimus / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D018799:Intercellular Adhesion Molecule-1 / Q000097:blood; D008297:Male; D008875:Middle Aged; D010766:Phosphorylation; D015539:Platelet Activation; D010975:Platelet Aggregation Inhibitors / Q000494:pharmacology / Q000627:therapeutic use; D012307:Risk Factors; D012720:Severity of Illness Index; D015607:Stents / Q000009:adverse effects*
chemical_list: D015415:Biomarkers; D010975:Platelet Aggregation Inhibitors; D018799:Intercellular Adhesion Molecule-1; D023201:CD40 Ligand; D000068338:Everolimus
keywords: Coronary stenting; endothelial injury; inflammation; platelet activation; soluble marker; therapeutic responsiveness