Coronary aspirate TNFα reflects saphenous vein bypass graft restenosis risk in diabetic patients

Abstract

BackgroundPatients with diabetes mellitus (DM) have an increased risk for periprocedural complications and adverse cardiac events after percutaneous coronary intervention. We addressed the potential for coronary microvascular obstruction and restenosis in patients with and without DM undergoing stenting for saphenous vein bypass graft (SVG) stenosis under protection with a distal occlusion/aspiration device.MethodsSVG plaque volume and composition were analyzed using intravascular ultrasound before stent implantation. Percent diameter stenosis was determined from quantitative coronary angiography before, immediately after and 6 months after stent implantation. Coronary aspirate was retrieved during stent implantation and divided into particulate debris and plasma. Total calcium, several vasoconstrictors, and tumor necrosis factor (TNF)α in particulate debris and coronary aspirate plasma were determined.ResultsPatients with and without DM had similar plaque volume, but larger necrotic core and greater particulate debris release in patients with than without DM (20.3±2.7 vs. 12.7±2.6% and 143.9±19.3 vs. 75.1±10.4 mg, P<0.05). The TNFα concentration in particulate debris and coronary aspirate plasma was higher in patients with than without DM (15.9±6.6 vs. 5.1±2.4 pmol/mg and 2.2±0.7 vs. 1.1±0.2 pmol/L, P<0.05), whereas total calcium and vasoconstrictors were not different. Patients with DM had a greater percent diameter stenosis 6 months after stent implantation than those without DM (22.17±5.22 vs. 6.34±1.11%, P<0.05). The increase in TNFα immediately after stent implantation correlated with restenosis 6 months later (r=0.69, P<0.05).ConclusionIn diabetics, particulate debris and coronary aspirate plasma contained more TNFα, which might reflect the activity of the underlying atherosclerotic process.Trial registrationURL: http://www.clinicaltrials.gov/ct2/results?term=NCT01430884; unique identifier: NCT01430884

The Impact of Diabetes Mellitus on Long‐Term Clinical Outcomes After Percutaneous Coronary Saphenous Vein Graft Interventions in the Drug‐Eluting Stent Era

“…Vein grafts degenerate over time due to the development of large, lipid‐rich, friable plaque comprised of necrotic debris, cholesterol crystals, and often thrombus . Intravascular ultrasound imaging studies have shown that the graft atherosclerosis in patients with diabetes mellitus has more necrotic core with unstable plaques; and after stent implantation there was more particulate debris release when compared to those without diabetes mellitus . Prior surgical literature has shown that recurrent ischemic events and vein graft stenoses were higher among diabetic patients compared with nondiabetics, leading to higher rates of repeat intervention at long‐term follow‐up .…”

Interaction of Risk Factors, Comorbidities, and Comedications with Ischemia/Reperfusion Injury and Cardioprotection by Preconditioning, Postconditioning, and Remote Conditioning

“…Epidemiological studies and clinical trials have clearly shown that both type I (insulin-dependent) and type II (noninsulin-dependent) diabetics are more prone to developing ischemic heart disease, including acute MI and post-MI complications (Otto et al, 2012;Baars et al, 2013). The diabetic heart is more susceptible to acute myocardial ischemia/reperfusion injury (Alegria et al, 2007;Marso et al, 2007).…”

Influence of stent implantation on erythrocyte aggregation in human native coronary arteries and saphenous vein grafts

“…To quantify the effect of coronary arterial and aspirate plasma on RBC aggregation, coronary arterial and aspirate plasma samples of patients (n=3; 40/60 v/v) were added to separated RBCs of healthy volunteers (n=3). We here used plasma from a subgroup of patients with leftover plasma samples from prior studies . Peripheral venous blood was taken from healthy volunteers with the blood group 0 to exclude blood group incompatibilities between the patients’ plasma and the RBCs of the healthy volunteers.…”

“…We here used plasma from a subgroup of patients with leftover plasma samples from prior studies. [1][2][3]27 Peripheral venous blood was taken from healthy volunteers with the blood group 0 to exclude blood group incompatibilities between the patients' plasma and the RBCs of the healthy volunteers.…”