Changes of Plasma B-Type Natriuretic Peptide Levels after High-Pressure Post-Dilation following Coronary Stent Deployment

Abstract

ObjectiveTo evaluate the changes of plasma B-type natriuretic peptide(BNP) levels after high-pressure post-dilation following coronary stent deployment.MethodsA total of 173 patients undergoing percutaneous coronary intervention for the left anterior descending artery were enrolled into the study. All patients were divided into two groups: the conventional group and the post-dilation group. The plasma BNP, troponin I(TnI), myocardial band isoenzyme of creatine kinase(CK-MB) levels and the serum high sensitive C-reactive protein(hs-CRP) levels immediately before and 24 hours after the interventional procedures were compared between the two groups.ResultsThere were no significant differences between the two groups in terms of clinical features, clinical and biochemical parameters, stent parameters, pre-procedural plasma BNP and TnI levels, pre-procedural serum hs-CRP levels, as well as pre- and post-procedural CK-MB levels (all P>0.05). In the conventional group, post-procedural plasma BNP levels were significantly reduced when compared with the pre-procedural levels, median(25th,75th) were 32.5 ng/L(15.0,52.4) vs. 37.7 ng/L(18.2,67.3), P = 0.001. In the post-dilation group, post-procedural plasma BNP levels were significantly increased when compared with the pre-procedural levels, median(25th,75th) were 53.5 ng/L(29.6,82.8) vs. 44.2 ng/L(17.15,70.7), P<0.0001. Post-procedural plasma TnI levels were also significantly increased when compared with the pre-procedural levels in both groups, median(25th,75th) were 0.02 ng/L(0.01,0.08) vs. 0.01 ng/L(0.01,0.01), 0.05 ng/L(0.01,0.35) vs. 0.01 ng/L(0.01,0.01), respectively, P<0.0001, so were the serum hs-CRP levels, median(25th,75th) were 3.3 mg/L(2.4,4.7) vs. 2.2 mg/L(1.4,3.3), 4.2 mg/L(3.175,5.825) vs. 2.3 mg/L(1.45,3.6), respectively, P<0.0001. Post-procedural plasma BNP, TnI and serum hs-CRP levels in the post-dilation group were significantly higher than those in the conventional group(all P<0.0001).ConclusionHigh-pressure post-dilation following coronary stent deployment resulted in a significant increase of plasma BNP levels, as well as plasma TnI levels and serum hs-CRP levels, which may be related to myocardial perfusion, more myocardial injury and more inflammation.

Influence of Stent Length on Periprocedural Outcomes After Primary Percutaneous Coronary Intervention in Patients with ST Segment Elevation Myocardial Infarction

“…The pathophysiological mechanisms of the SF-NR phenomenon, including ischemia-reperfusion injury, microvascular spasm, distal thromboembolism, endothelial dysfunction, and individual susceptibility, are complex. 16,[18][19][20] Inadequate epicardial coronary blood supply can result in endothelial cell dysfunction and interstitial edema of cardiomyocytes. This can compress the microvascular lumen and increase its stenosis, ultimately leading to the development of anatomical SF-NR.…”

“…Excessive post-dilation during primary PCI may increase type B natriuretic peptide, troponin I and hypersensitive C-reactive protein levels, resulting in MVD and consequently increasing the risk of SF-NR. 20 However, a recent prospective observational study combining coronary physiology and intracoronary imaging showed that post-dilation in patients with STEMI is beneficial in increasing fractional flow reserve after PCI, with no significant effect on coronary microcirculation overall. 27 In this study, balloon post-dilation did not increase the risk of SF-NR.…”

The Association Between Stent Postdilation and Death in Patients With Acute Coronary Syndrome

“…One recent study showed a significantly increased level of plasma B-type natriuretic peptide, a biomarker for heart failure, and troponin Ⅰ, a biomarker of myocardial injury, after stent postdilation. 4…”

The Clinical and Angiographic Outcomes of Postdilation after Percutaneous Coronary Intervention in Patients with Acute Coronary Syndrome: A Systematic Review and Meta-Analysis

“…All patients with coronary artery disease undergoing PCI were included in that meta-analysis, including patients with stable coronary artery disease. e levels of troponin I and highly sensitive C-reactive protein were elevated after stent expansion, suggesting more myocardial damage and inflammation [37]. e primary lesion in patients with acute coronary syndrome is more unstable due to more necrotic cores and fewer fibrous fatty plaques than in patients with stable coronary artery disease [38]; the elevation of cardiac troponin occurs in lesions with a large necrotic core area and in lipid-rich lesions [39,40].…”

“…erefore, the deployment of postdilation in patients with ACS will increase the risk of myocardial damage, which may be the reason for increased all-cause death in this meta-analysis. In addition, studies have shown that the levels of plasma B-type natriuretic peptide significantly increase following the postdilation, which is a biomarker of heart failure [37]. Long-term heart failure can also cause an increased death.…”