Abstract
Background
Systemic inflammation after coronary intervention identifies patients at increased risk of subsequent cardiac events. Cardiac events, especially in-stent restenosis, are less frequent after use of sirolimus-eluting stent (SES) compared with paclitaxel-eluting stent (PES). However, the underlying mechanism for this disparity is not well investigated. We hypothesize that an attenuated inflammatory response after SES implantation may be a contributor.
Purpose
In the present study, we sought to determine the early inflammatory response after SES implantation in patients with single-vessel disease compared with PES implantation, and evaluate the relationship between inflammatory response and late clinical outcomes in a randomized design.
Methods
Thirty-two patients with stable angina were randomly enrolled into the two groups, SES or PSE group (n = 16 respectively). Peripheral blood samples were taken before PCI, 24 and 72 h after stenting. The plasma concentrations of C-reactive protein (CRP) and interleukin-6 (IL-6) were determined by enzyme-linked immunosorbent assay (ELISA). The clinical and angiographic follow-up was performed at 8 months after stenting.
Results
The data showed that there was no significant difference in clinical and angiographic baseline characteristics between the two groups. The plasma CRP and IL-6 levels at 24 h after stenting were significant higher in both groups compared with baseline (p < 0.01 respectively). Likewise, the CRP levels at 72 h after stenting were also significant higher compared with baseline in both groups (p < 0.01 respectively). However, the plasma levels of IL-6 at 24 h and CRP at 72 h after stenting were higher in PES group compared with SES group (p < 0.05). At 8 months follow-up, the rates of major adverse cardiac events, target lesion revascularization, in-stent and in-segment restenosis were similar in both groups. However, the late loss in both in-stent and in-segment was significantly higher in the PES group than in SES group (p < 0.001 respectively).
Conclusions
Our findings suggest that a drug-eluting stent implantation could trigger a systemic inflammatory response as previously demonstrated. However, SES implantation results in a lower inflammatory response compared with PES implantation, which seems to be associated with greater late of in-stent and in-segment loss at 8-month follow-up with PES.
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Acknowledgments
This article is partly supported by a Fu Wai Hospital Grant (2004190), National Natural Scientific Foundation (30670861, 30871055), Beijing Natural Scientific Foundation (7082081), National Project in the Five-year Period Grant, and Specialized Research Fund for the Doctoral Program of Higher Education of China (20060023044, 20070023047) awarded by Dr. Jian-Jun Li, MD, PhD.
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Li, JJ., Yan, HB., Xiang, XP. et al. Comparison of Changes in Early Inflammatory Markers Between Sirolimus- and Paclitaxel-Eluting Stent Implantation. Cardiovasc Drugs Ther 23, 137–143 (2009). https://doi.org/10.1007/s10557-008-6149-0
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DOI: https://doi.org/10.1007/s10557-008-6149-0