Drug-Eluting Stent, but Not Bare Metal Stent, Accentuates the Systematic Inflammatory Response in Patients

Abstract

Objective: The systematic pro-inflammatory responses after percutaneous coronary intervention with drug-eluting stents (DES) remain poorly defined. Therefore, we compared the systematic pro-inflammatory state of circulating mononuclear cells (MNCs) between DES and bare metal stent (BMS) implantation. Methods: Patients with indications for treatment with stents were randomized in a 1:1 ratio to placement of DES or BMS. The primary endpoint was a change of pro-inflammatory state at 12 weeks post-procedure. Results: Thirty-six consecutive patients received DES or BMS. At 12 weeks after stent implantation, the lipid profile and high-sensitivity C-reactive protein (hs-CRP) improved significantly in both groups. The mRNA levels and plasma concentrations of interleukin-6, tumor necrosis factor-a and matrix metalloproteinase-9 were significantly elevated in the DES group, which was not observed in the BMS group. An increase in NF-γB binding activity and a decrease in PPAR-γ expression in MNCs were observed in the DES group, along with increases in IγB phosphorylation and p50 expression. However, similar changes were not observed in the BMS group. Conclusions: Systematic inflammatory responses were accentuated after the patients were treated percutaneously with DES, despite their improved lipid profile and hs-CRP. These data may provide fundamental information for optimizing therapeutic strategy in the era of DES.

Metformin ameliorates the proinflammatory state in patients with carotid artery atherosclerosis through sirtuin 1 induction

“…NF-kB DNA binding activity was measured with NF-kB transcription factor assay kit (Abcam) according to the manufacturers' instructions. 20 Short interfering RNA transfection in MNCs. Human short interfering-sirtuin 1 (si-SIRT1) and mock short interfering RNA (siRNA) were obtained from Santz Cruz Biotechnology, and transient siRNA transfection was carried out according to the protocol of the manufacturer as described previously.…”

Pioglitazone Attenuates Drug-Eluting Stent-Induced Proinflammatory State in Patients by Blocking Ubiquitination of PPAR

“…DES-induced inflammatory reaction has been found as early as 30 days after implantation but progressed in frequency and severity through 90 to 180 days in porcine model [ 1 ]. Furthermore, our previous studies found that DES implantation induced specific systematic inflammatory state, as evidenced by the enhanced NF- κ B activity, suppressed PPAR- γ activity, and elevated plasma inflammatory factors, compared with no-stent implantation or bare metal stent (BMS) implantation [ 4 , 5 ]. However, how to refine DES-induced proinflammation remains unknown.…”

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

“…As a result, possible systemic anti inflammatory effects of DES, besides their local effects, were emphasized again [15] . In 2014, Liu et al published a research about the same subject with the new generation stents [9] . Thirty six stable patients were randomised in 1:1 manner to everolimus type DES and BMS.…”

“…Recently, there has been published data about the prolonged and pronounced systemic inflammatory response triggered by DES, in contrary to their local anti-inflammatory properties [9] . When we have a consensus and exact data in this topic in the future, we may prescribe much intense anti-inflammatory regimens such as higher dose statins for the patients with DES.…”

“…In addition to those trials done with first generation DES like sirolimus and paclitaxel, in 2014 a new trial with new generation DES, everolimus, was published. As a result of this recent trial, DES were shown to increase systemic inflammatory response more than the BMS [9] . Our aim in this trial was to test the hypothesis that there would be less increase in post procedural CRP in DES group when compared to BMS group.…”