Inflammatory Response to Coronary Stent Implantation in Patients with Unstable Angina

Abstract

Previous evidence has shown that coronary angioplasty leads to the release of inflammatory mediators. In this study, we sought to characterize the systemic inflammatory response after coronary stent implantation in patients with unstable angina by measuring different protein markers. Peripheral blood samples were taken before and 24 h, 48 h, and 7 days after successful coronary stenting in 58 patients. Several markers of acute-phase response were determined: C-reactive protein (CRP), alpha2-macroglobulin, haptoglobin, acid alpha1-glycoprotein, prealbumin and albumin. Besides, proinflammatory cytokines (tumor necrosis factor-alpha, IL-6, IL-8) and the anti-inflammatory cytokine IL-10 were also measured. We have found that coronary angioplasty with stent implantation produces a systemic inflammatory response with a rise in inflammation markers concentration. CRP plasma levels declined 1 week after the intervention, but the other marker levels were even higher after 7 days. IL-6 was the only cytokine whose plasma levels significantly increased in peripheral blood after stenting, with a rise after 24 h, maintained after 48 h, and decreased to near-basal levels after 1 week. There was a good correlation between CRP and IL-6 plasma levels (r=0.5, p<0.001). IL-10 levels were slightly decreased after 24 h. Although no significant differences in the means at different time points were found, there was a decrease in IL-10 in most patients 24 h after the intervention. These results indicate that coronary stent implantation induces a systemic inflammatory reaction, with a temporal increase in the concentration of the inflammation markers, especially CRP and IL-6. Since these markers had been previously used as prognostic markers, this needs to be taken into account in patients undergoing stent implantation.

Prolonged CRP Increase After Percutaneous Coronary Intervention Is Associated with High Thrombin Concentrations and Low Platelet’ Response to Clopidogrel in Patients with Stable Angina

“…Our observation of early CRP increase after PCI is in accordance with other clinical trials [19,22]. Our study followed post-procedural CRP in the long-term, which only few other studies assessed [23].…”

The beneficial effect of high loading dose of rosuvastatin before percutaneous coronary intervention in patients with acute coronary syndrome

“…The increase in serum CRP concentration follows the increase in serum IL-6 concentration by 12-36 h, reaching its peak value by 24 h after the procedure [27,28]. Bonz et al [28] found the increase in the serum concentrations of both IL-6 and CRP to be more obvious in patients with concomitant post-procedural troponin T elevation.…”

Percutaneous coronary intervention triggers a systemic inflammatory response in patients treated for in-stent restenosis – comparison with stable and unstable angina

“…At baseline unstable patients undergoing PCI presented high CRP and SAA levels along with an enhanced postprocedural inflammatory reaction [13,14] as did stable patients referred for the intervention [11,15,16]. Moreover, the presence of myocardial necrosis in troponin I positive subjects magnifies the systemic manifestation of inflammatory process [30,31].…”