Coronary Angioplasty Induces a Systemic Inflammatory Response

Azar, Rabih R.; McKay, Raymond G.; Kiernan, Francis J.; Seecharran, Bonnie; Feng, Yue; Fram, Daniel B.; Wu, Alan H.B.; Waters, David D.

doi:10.1016/s0002-9149(97)00726-1

Cited by 84 publications

(49 citation statements)

References 11 publications

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“…PTCA triggers a systemic inflammatory response by inducing an ischemic reperfusion cycle through repeated balloon inflations, which can be followed by tissue injury and impaired antioxidant status (Kloner et al 1991;Liuzzo et al 1994;Azar et al 1997;Ridker et al 1997;Ambrosio and Tritto 1998). Inflammatory marker levels, such as CRP, IL-1 and IL-6, increase after PTCA (Kloner et al 1991;Balligand et al 1994;Azar et al 1997;Matsumara et al 1998;Wildhirt et al 1999).…”

Section: Discussionmentioning

confidence: 99%

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Suppression of Angioplasty-Related Inflammation by Pre-Procedural Treatment with Trimetazidine

Kuralay

Altekin

Yazlar

et al. 2006

Tohoku J. Exp. Med.

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Percutaneous transluminal coronary angioplasty (PTCA) has been recognized as a reliable treatment procedure for acute reversible ischemia and reperfusion. Ischemic reperfusion cycle in PTCA leads to the systemic inflammation and extensive tissue injury by the production of reactive oxygen species including nitric oxide (NO) radicals. In patients with coronary artery disease, undergoing PTCA, the effects of trimetazidine (TMZ), a piperazine-derivative anti-anginal drug, were studied on several indirect markers of systemic inflammatory response: tumor necrosis factor-α (TNF-α ), C-reactive protein (CRP) and NO products (nitrite and nitrate). Patients (n = 11 each group) were untreated or pre-treated with TMZ (20 mg per orally three times a day), begun three days prior to PTCA, and marker levels were measured before the start of TMZ therapy (baseline), just before PTCA (0 hr), and 4, 24, and 48 hrs after PTCA. The baseline levels of markers were not significantly different between the untreated and pre-treated patients. In contrast, all parameters were lower in the TMZtreated group than those in the matched control group in the pre-and post-angioplasty periods. Interestingly, in the TMZ group, CRP and nitrite levels were significantly lower than in the control group at each time point of the pre-and post-angioplasty periods, but the TNF-α levels were significantly decreased only in the post-angioplasty period. Preprocedural treatment with oral TMZ for three days significantly suppressed the elevation of inflammatory markers before and shortly after PTCA. We suggest the usefulness of TMZ in preventing inflammatory cardiovascular events after PTCA.trimetazidine; percutaneous transluminal coronary angioplasty; C-reactive protein; nitric oxide; tumor necrosis factor-α .

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Section: Discussionmentioning

confidence: 99%

“…Inflammatory marker levels, such as CRP, IL-1 and IL-6, increase after PTCA (Kloner et al 1991;Balligand et al 1994;Azar et al 1997;Matsumara et al 1998;Wildhirt et al 1999).…”

Section: Discussionmentioning

confidence: 99%

Suppression of Angioplasty-Related Inflammation by Pre-Procedural Treatment with Trimetazidine

Kuralay

Altekin

Yazlar

et al. 2006

Tohoku J. Exp. Med.

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“…3 In both processes, inflammatory and thrombotic mechanisms combine to obstruct or occlude the vascular lumen. 4 Activated platelets potentiate thrombus formation and ultimately promote restenosis. 5 Present therapy in ACS aims to limit platelet aggregation mechanisms by use of glycoprotein (GP) IIb/IIIa receptor antagonists 6 or thienopyridines.…”

mentioning

confidence: 99%

Increased Platelet Binding to Circulating Monocytes in Acute Coronary Syndromes

et al. 2002

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Background — Present therapies for acute coronary syndromes aim toward limiting platelet–platelet adhesion and aggregation processes. However, platelet–leukocyte interactions may contribute importantly to disease progression in the arterial wall. Recent studies suggest that prevention of platelet–leukocyte binding via P-selectin glycoprotein ligand-1 (PSGL-1) may be beneficial in animal models of vascular injury. Methods and Results — P-selectin–PSGL-1 interactions were found to account for most platelet–monocyte binding observed in peripheral blood samples from healthy donors. However, a significant component of observed adhesion was calcium independent, involving neither PSGL-1 nor P-selectin. Platelet–monocyte interactions were examined in 52 patients admitted within 14 hours of symptom onset, with acute coronary syndromes defined as unstable angina (n=12) and acute myocardial infarction (n=13) or noncardiac chest pain (n=27). When compared with patients with noncardiac chest pain, significantly elevated levels of platelet–monocyte binding were found in patients with acute myocardial infarction (70.1±15.4% versus 45.4±23.3%; P <0.01) and unstable angina (67.4±12.9% versus 45.4±23.3%; P >0.01). Calcium-independent platelet–monocyte binding was significantly elevated in myocardial infarction patients alone (14.7±7.7% versus 6.1±5.96%; P <0.001). Conclusions — There is evidence for a significant P-selectin–independent molecular component to the platelet–monocyte conjugation observed in peripheral blood. Patients with myocardial infarction and unstable angina demonstrate increased total binding of platelets to monocytes. Additionally, calcium-independent adhesion was significantly elevated in patients with evidence of myocardial infarction. These findings demonstrate that novel cation-independent adhesion mechanisms may mediate platelet–monocyte binding, representing a new therapeutic target after vascular injury associated with myocardial infarction.

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“…Besides the known local anti inflammatory effects of DES, whether the systemic anti inflammation is also playing role at this benefit or not, has been subject to question. After the stent implantation, the plaque rupture and arterial wall injury trigger the inflammation and this can be assessed by the systemic inflammatory marker, CRP [12] . Increased CRP levels were shown to be related with increased restenosis rates.…”

Section: Discussionmentioning

confidence: 99%

Comparison of the Effects of Bare Metal Stents and Drug Eluting Stents on C- Reactive Protein Levels

Özyüncü¹

2015

JHC

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Aim: It's suggested that drug eluting stents (DES) may have systemic anti inflammatory properties and this can play a role in decreased restenosis rates. We aimed to compare bare metal stents (BMS) and DES on their effects on C-reactive protein (CRP) levels, a good marker of systemic inflammation. We also aimed to investigate the relation between the inflammation levels and myonecrosis and adverse cardiac events. Methods: Patients undergoing elective stent implantation were grouped as BMS (n = 70) and DES (n = 42). Basal and 24th hour postprocedural CRP and CKMB levels were measured and the difference (Δ) was compared between the groups. The patients were followed up for adverse cardiac events for one year. Results: Mean age was 62 ± 11 and 75% were males. There was significant CRP rise in both groups at 24 th hour, but the ΔCRP was 2.1 (0.5-6.2) mg/L in BMS and 2.3 (0.2-5.2) mg/L in DES group, the difference wasn't statistically significant (p = 0.703). ΔCKMB and adverse cardiac event rates were similar between the two groups (p = 0.897 and p = 0.785). There was no correlation between ΔCRP and ΔCKMB (r = -0.090 and p = 0.459 for BMS, r = 0.158 and p = 0.318 for DES). The effect of ΔCRP on the incidence of adverse cardiac events was not significant (p = 0.349 for BMS, p = 0.135 for DES). Conclusion: Our findings reveal that patients with BMS and DES implantation exhibit similar grade of systemic inflammation after the procedure. At similar levels of systemic inflammation, the local anti-inflammatory properties of DES can play a role at decreased restenosis rates.

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Coronary Angioplasty Induces a Systemic Inflammatory Response

Cited by 84 publications

References 11 publications

Suppression of Angioplasty-Related Inflammation by Pre-Procedural Treatment with Trimetazidine

Suppression of Angioplasty-Related Inflammation by Pre-Procedural Treatment with Trimetazidine

Increased Platelet Binding to Circulating Monocytes in Acute Coronary Syndromes

Comparison of the Effects of Bare Metal Stents and Drug Eluting Stents on C- Reactive Protein Levels

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