Persistent Inflammatory Activity in Blood Cells and Artery Tissue from Patients with Previous Bare Metal Stent

Abstract

BackgroundStudies have pointed out a higher mortality after coronary artery bypass surgery (CABG) in patients with stent.ObjectiveTo evaluate inflammatory markers in peripheral blood cells and in coronary artery tissue samples obtained during CABG in patients with stent compared to controls.MethodsThe case series consisted of two groups, one with previous stent implantation (n = 41) and one control (n = 26). The expression of the LIGHT, IL-6, ICAM, VCAM, CD40, NFKB, TNF, IFNG genes was analyzed in peripheral blood cells collected preoperatively. The coronary artery was evaluated for: interleukin-6, ICAM, VCAM, CD40, NFKB, TNF-alpha and IFN-gamma by immunohistochemistry. A total of 176 tissue samples were grouped for analysis in: A1- arteries with stent (n = 38); A2- native arteries from patients with stent in another artery (n = 68); and A3- arteries without stent from controls undergoing routinely CABG surgery (n = 70). A significance level of 0.05 was adopted.ResultsPatients with stent showed higher TNF (p = 0.03) and lower CD40 gene expression (p = 0.01) in peripheral blood cells than controls without stent. In coronary artery samples, the TNF-alpha protein staining was higher in the group A1, not only in the intima-media layer (5.16 ± 5.05 vs 1.90 ± 2.27; p = 0.02), but also in the adipose tissue (6.69 ± 3.87 vs 2.27 ± 4.00; p < 0.001). Furthermore, group A1 had a higher interleukin-6 protein staining in adipose tissue than group A3 (p = 0.04).ConclusionWe observed a persistently higher systemic TNF expression associated with exacerbated TNF-alpha and interleukin-6 local production in patients with stents. This finding may contribute to a worse clinical outcome.

Persistent inflammatory activity in blood cells and artery tissue from patients with previous bare metal stent

“…Those data show the relevance of the findings of the study by Farsky et al 1 and suggest that patients receiving bare metal stents might need additional anti-inflammatory therapy. However, new prospective studies of efficacy and safety, in addition to lower cost of that therapy, are required to its definitive incorporation into clinical practice.…”

“…The TNF-alpha, another biomarker of higher expression evidenced in the study by Farsky et al., 1 seems to be implicated in atherosclerotic plaque instability. 4 …”

“…The interesting article by Farsky et al 1 examined the persistence of inflammatory activity after bare metal stent implantation in patients later submitted to coronary artery bypass grafting (CABG).…”

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